- Use of strong vs weaker inhibitors of serotonin reuptake is associated with a somewhat lower risk for ischaemic stroke or transient ischaemic attack (TIA), but not myocardial infarction (MI).
Why this matters
- High comorbidity of depression, cardiovascular disease.
- Relative to users of antidepressants weakly inhibiting serotonin reuptake, users of strong inhibitors had lower ischaemic stroke/TIA rate (rate ratio [RR], 0.88; 95% CI, 0.80-0.97).
- Effect size was attenuated in some sensitivity analyses.
- No significant difference in MI rate (RR, 1.00; 95% CI, 0.87-1.15).
- For selective serotonin reuptake inhibitors (SSRIs) alone, strong vs intermediate inhibitors:
- Similar rate of ischaemic stroke/TIA (RR, 0.98; 95% CI, 0.92-1.04).
- Borderline higher rate of MI (RR, 1.09; 95% CI, 1.00-1.18).
- UK population-based cohort study of adult new users of SSRIs or third-generation antidepressants, mean follow-up of ~5.7 years.
- 15,860 cases of ischaemic stroke/TIA to 473,712 controls.
- 8626 cases of MI to 258,022 controls.
- Degree of inhibition:
- Strong: duloxetine, fluoxetine, paroxetine, sertraline;
- Intermediate: citalopram, escitalopram, fluvoxamine, venlafaxine;
- Weak: mianserin, mirtazapine, nefazodone, reboxetine, agomelatine, viloxazine.
- Main outcomes: stroke/TIA, MI.
- Funding: Canadian Institutes of Health Research.
- Residual confounding.
- Specialist prescriptions not captured.
- Possible outcome misclassification.