SSRI use in postmenopausal women was associated with increased stroke risk (HR 1.45; 95% CI 1.08-1.97) and all-cause mortality (HR 1.32; 95% CI 1.10-1.59) compared with no antidepressant use.
Cohort (n=136,293)
Yes
Does new antidepressant use increase the risk of incident cardiovascular morbidity and all-cause mortality in postmenopausal women?
In postmenopausal women, new use of SSRIs or TCAs is associated with an increased risk of all-cause mortality and stroke, but not coronary heart disease, though absolute event risks are low.
Effect estimate: HR 1.45 (95% CI 1.08-1.97)
Absolute Event Rate: 4.16% vs 2.99%
BACKGROUND: Antidepressants are commonly prescribed medications, but their effect on cardiovascular morbidity and mortality remains unclear. METHODS: Prospective cohort study of 136 293 community-dwelling postmenopausal women in the Women's Health Initiative (WHI). Women taking no antidepressants at study entry and who had at least 1 follow-up visit were included. Cardiovascular morbidity and all-cause mortality for women with new antidepressant use at follow-up (n = 5496) were compared with those characteristics for women taking no antidepressants at follow-up (mean follow-up, 5.9 years). RESULTS: Antidepressant use was not associated with coronary heart disease (CHD). Selective serotonin reuptake inhibitor (SSRI) use was associated with increased stroke risk (hazard ratio HR,1.45, 95% CI, 1.08-1.97) and all-cause mortality (HR,1.32 95% CI, 1.10-1.59). Annualized rates per 1000 person-years of stroke with no antidepressant use and SSRI use were 2.99 and 4.16, respectively, and death rates were 7.79 and 12.77. Tricyclic antidepressant (TCA) use was associated with increased risk of all-cause mortality (HR,1.67 95% CI, 1.33-2.09; annualized rate, 14.14 deaths per 1000 person-years). There were no significant differences between SSRI and TCA use in risk of any outcomes. In analyses by stroke type, SSRI use was associated with incident hemorrhagic stroke (HR, 2.12 95% CI, 1.10-4.07) and fatal stroke (HR, 2.10 95% CI, 1.15-3.81). CONCLUSIONS: In postmenopausal women, there were no significant differences between SSRI and TCA use in risk of CHD, stroke, or mortality. Antidepressants were not associated with risk of CHD. Tricyclic antidepressants and SSRIs may be associated with increased risk of mortality, and SSRIs with increased risk of hemorrhagic and fatal stroke, although absolute event risks are low. These findings must be weighed against quality of life and established risks of cardiovascular disease and mortality associated with untreated depression.
Jordan W. Smoller (2009) conducted a cohort in Postmenopausal women (n=136,293). Antidepressants (SSRIs and TCAs) vs. No antidepressants was evaluated on Stroke (SSRI vs no antidepressant) (HR 1.45, 95% CI 1.08-1.97). SSRI use in postmenopausal women was associated with increased stroke risk (HR 1.45; 95% CI 1.08-1.97) and all-cause mortality (HR 1.32; 95% CI 1.10-1.59) compared with no antidepressant use.