Abstract WP402: Risks and Benefits of Selective Serotonin Reuptake Inhibitor Use Among Survivors of Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Patryk P Kubiszewski ◽  
Christina Kourkoulis ◽  
Zora DiPucchio ◽  
Kristin Schwab ◽  
Mahmut E Gurol ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Intracerebral Hemorrhage ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Recurrence Risk ◽  
Selective Serotonin ◽  
Prior History ◽  
Depression Severity ◽  
Risks And Benefits ◽  
Race Ethnicity

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are widely used to treat post-stroke depression, but they increase Intracerebral Hemorrhage (ICH) incidence in the general population. ICH survivors must therefore balance ICH recurrence risk with depression treatment benefits when considering SSRI use. We sought to determine risks and benefits of SSRI use among survivors of primary ICH. Hypothesis: SSRI exposure following ICH is associated with increased recurrent ICH risk and decreased depression severity. Methods: We analyzed data from the MGH-ICH study. We collected baseline patient information (demographics, race/ethnicity, medical history), ICH characteristics (location, size, associated functional impairment) and determined genetic (APOE e2/e4) and MRI markers of underlying small vessel disease. Participants were followed by phone and EMR review to determine: 1) recurrent ICH events; 2) onset and severity of depression (using the GDS-4 scale). We conducted univariable and multivariable analyses for ICH recurrence risk and depression severity as a function of SSRI exposure. We conducted a subset analysis for patients with one or more of the following characteristics associated high ICH recurrence risk: 1) probable or possible CAA diagnosis (Boston criteria); 2) presence of APOE e2/e4 gene variants; 3) prior history of ICH/TIA/ischemic stroke; 4) black or Hispanic race/ethnicity. Results: We enrolled and followed longitudinally 1010 ICH survivors. SSRI exposure was associated with both ICH recurrence (HR 1.22, 95% CI 1.06 - 1.40) and improvement of depressive symptoms (OR 0.73 for increase in GDS-4 score quartiles, 95% CI 0.59 - 0.90). Among individuals at high ICH recurrence risk SSRI use was associated with higher risk for ICH recurrence compared to all other ICH survivors (interaction p = 0.012). SSRI effect on depressive symptoms did not differ between high ICH recurrence risk individuals and all other participants. Conclusions: SSRI exposure is associated with both improvement in depressive symptoms after ICH and with increased hemorrhage recurrence risk. Clinical history, neuroimaging data and genetic biomarkers may represent viable tools to identify ICH survivors more likely to safely tolerate SSRI use.

scholarly journals Intracerebral Hemorrhage and Outcome After Thrombolysis in Stroke Patients Using Selective Serotonin-Reuptake Inhibitors

Stroke ◽  
2017 ◽  
Vol 48 (12) ◽  
pp. 3239-3244 ◽  
Author(s):  
Jan F. Scheitz ◽  
Guillaume Turc ◽  
Linda Kujala ◽  
Alexandros A. Polymeris ◽  
Mirjam R. Heldner ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Stroke Patients

scholarly journals Selective serotonin reuptake inhibitors and pregnancy: A review of maternal, fetal and neonatal risks and benefits

2013 ◽  
Vol 6 (4) ◽  
pp. 155-158 ◽  
Author(s):  
Zbigniew Marchocki ◽  
Noirin E Russell ◽  
Keelin O’ Donoghue
Keyword(s):  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Childbearing Age ◽  
Pharmacological Interventions ◽  
Risks And Benefits ◽  
Potential Risks ◽  
Psychiatric Conditions ◽  
In Pregnancy

Depression is common in women of childbearing age. Whereas non-pharmacological interventions are recommended as first line interventions, pharmacological treatment may be required. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants in pregnancy. Ideally, discussion of the risks and benefits of SSRI use in pregnancy should occur prior to pregnancy. The potential risks of psychotropic medications need to be balanced against the risks associated with untreated psychiatric conditions and the discontinuation of necessary medications.

scholarly journals Sex differences in depressive symptoms and tolerability after treatment with selective serotonin reuptake inhibitor antidepressants: Secondary analyses of the GENPOD trial

2021 ◽  
pp. 026988112098641
Author(s):  
Marilia Gougoulaki ◽  
Glyn Lewis ◽  
David J Nutt ◽  
Tim J Peters ◽  
Nicola J Wiles ◽  
...  
Keyword(s):  
Sex Differences ◽  
Depressive Symptoms ◽  
Reuptake Inhibitor ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Menopausal Status ◽  
Physical Symptoms ◽  
Treatment Discontinuation ◽  
Selective Serotonin ◽  
Secondary Analyses

Background: Differences in serotonergic neurotransmission could lead to sex differences in depressive symptoms and tolerability after treatment with selective serotonin reuptake inhibitors (SSRIs). Aims: We investigated whether women have greater reductions in depressive symptoms than men after treatment with an SSRI (citalopram) compared with a noradrenaline reuptake inhibitor (reboxetine) control, and after antidepressant treatment irrespective of class. We also investigated tolerability and the influence of menopausal status. Methods: Secondary analyses of the GENPOD (GENetic and clinical Predictors Of treatment response in Depression) trial. Six hundred and one people with depression were recruited from UK primary care and randomized to citalopram or reboxetine. Beck Depression Inventory (BDI-II) score at 6 weeks was the primary outcome. Secondary outcomes included BDI-II score at 12 weeks, and physical symptoms and treatment discontinuation. We calculated main effects and interaction terms using linear and logistic regression models. Results: There was no evidence that women experienced greater reductions in depressive symptoms than men when treated with citalopram compared with reboxetine. We also found no evidence of sex differences at six or 12 weeks (irrespective of antidepressant class): men scored −0.31 (95% confidence interval (CI) −2.23 to 1.62) BDI-II points lower than women at six weeks and −0.44 (95% CI −2.62 to 1.74) points lower at 12 weeks. There was no evidence of sex differences in physical symptoms or treatment discontinuation and no evidence for an influence of menopausal status. Conclusion: Citalopram was not more effective in women compared with men and there was no difference in tolerability. Women and men had similar prognosis after SSRI treatment and similar prognosis regardless of antidepressant class. Findings were unaltered by menopausal status.

scholarly journals Selective Serotonin Reuptake Inhibitors and Intracerebral Hemorrhage Risk and Outcome

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1135-1141
Author(s):  
Li Liu ◽  
Matthew Fuller ◽  
Tyler P. Behymer ◽  
Yisi Ng ◽  
Thomas Christianson ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Reuptake Inhibitors ◽  
Selective Serotonin ◽  
Hemorrhage Risk

scholarly journals Prenatal exposure to selective serotonin reuptake inhibitors and autistic symptoms in young children: another red herring?

2014 ◽  
Vol 205 (2) ◽  
pp. 105-106 ◽  
Author(s):  
Irene Petersen ◽  
Stephen Evans ◽  
Irwin Nazareth
Keyword(s):  
Depressive Symptoms ◽  
Selective Serotonin Reuptake Inhibitor ◽  
Prenatal Exposure ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Autistic Traits ◽  
Selective Serotonin ◽  
Autistic Symptoms ◽  
Depression In Pregnancy ◽  
In Pregnancy

SummaryIn this issue, El Marroun et al suggest an association between prenatal selective serotonin reuptake inhibitor (SSRI) exposure and autistic traits in children, as well as an association with prenatal depressive symptoms. However, SSRIs may be mere markers of severity of underlying illnesses and it may be premature to reach such conclusions about effects of treatment. Studies like this raise concerns as this may fuel further anxiety and guilt among women who are faced with depression in pregnancy and possibly leave some women without treatment.

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