Selective serotonin reuptake inhibitor exposure was associated with an increased risk of intracranial hemorrhage (adjusted RR 1.51; 95% CI 1.26-1.81) compared to no SSRI exposure.
Meta-Analysis
Does selective serotonin reuptake inhibitor (SSRI) exposure increase the risk of CNS hemorrhage compared to no SSRI exposure?
SSRI exposure is associated with a moderately increased relative risk of intracerebral and intracranial hemorrhage, which is further elevated when combined with oral anticoagulants, though absolute risks are likely very low.
Effect estimate: RR 1.51 (95% CI 1.26-1.81)
OBJECTIVE: We synthesized the epidemiologic evidence concerning selective serotonin reuptake inhibitor (SSRI) exposure and the risk of CNS hemorrhage. METHODS: We searched for controlled observational studies comparing SSRI therapy with a control group not receiving SSRIs. We used DerSimonian and Laird fixed effect models to compute summary risk associations. RESULTS: Intracranial hemorrhage was related to SSRI exposure in both unadjusted (rate ratio RR 1.48, 95% confidence interval CI 1.22-1.78) and adjusted analyses (RR 1.51, 95% CI 1.26-1.81). Intracerebral hemorrhage was also associated with SSRI exposure in both unadjusted (RR 1.68, 95% CI 1.46-1.91) and adjusted (RR 1.42, 95% CI 1.23-1.65) analyses. In a subset of 5 studies (3 of intracranial hemorrhage and 1 each reporting hemorrhagic stroke and intracerebral hemorrhage), SSRI exposure in combination with oral anticoagulants was associated with an increased risk of bleeding compared with oral anticoagulants alone (RR 1.56, 95% CI 1.33-1.83). When all studies were analyzed together, increased risk was seen across cohort studies (1.61, 95% CI 1.04-2.51), case-control studies (odds ratio OR 1.34, 95% CI 1.20-1.49), and case-crossover studies (OR 4.24, 95% CI 1.95-9.24). CONCLUSIONS: SSRI exposure is associated with an increased risk of intracerebral and intracranial hemorrhage, yet given the rarity of this event, absolute risks are likely to be very low.
Hackam et al. (Thu,) conducted a meta-analysis in CNS hemorrhage. Selective serotonin reuptake inhibitors (SSRIs) vs. Control group not receiving SSRIs was evaluated on Intracranial hemorrhage (RR 1.51, 95% CI 1.26-1.81). Selective serotonin reuptake inhibitor exposure was associated with an increased risk of intracranial hemorrhage (adjusted RR 1.51; 95% CI 1.26-1.81) compared to no SSRI exposure.
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