Pan, 2011 Depression and Incident Stroke in Women

[Altostrata]

This study found that women taking antidepressants were at higher risk of stroke whether they were depressed or not. Bizarrely, the study concludes that it was depression, not the antidepressant use, that elevated the stroke risk. Yes, that antidepressant cheerleading mill Harvard was involved.

 

Depression and Incident Stroke in Women

STROKEAHA.111.617043 Published online before print August 11, 2011

 

An Pan, PhD;

Olivia I. Okereke, MD, SM;

Qi Sun, MD, ScD;

Giancarlo Logroscino, MD, PhD;

JoAnn E. Manson, MD, DrPH;

Walter C. Willett, MD, DrPH;

Alberto Ascherio, MD, DrPH;

Frank B. Hu, MD, PhD;

Kathryn M. Rexrode, MD

 

Correspondence to Kathryn M. Rexrode, MD, Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215. E-mail krexrode@partners.org

 

Full text here.

 

Abstract from the paper

 

Background and Purpose—Depression has been associated with an increased risk of coronary heart disease, but prospective data for the association with stroke are limited.

 

Methods—We followed-up 80 574 women aged 54 to 79 years in Nurses' Health Study without a history of stroke from 2000 to 2006. Depressive symptoms were assessed at multiple time points by a Mental Health Index score (1992, 1996, and 2000), and clinical significant depressive symptoms were defined as a score ≤52. Antidepressant medication use was asked biennially beginning in 1996, and physician-diagnosed depression was reported biennially beginning in 2000. Depression was defined as currently reporting or having a history of any of these 3 conditions.

 

Results—During 6 years of follow-up, 1033 incident strokes were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 (95% confidence interval [CI], 1.13–1.48) for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a Mental Health Index score ≤52 or diagnosed depression (HR, 1.39; 95% CI, 1.15–1.69) or not (HR, 1.31; 95% CI, 1.03–1.67). Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke (HR, 1.41; 95% CI, 1.18–1.67), whereas individuals who only had a history of depression were at nonsignificantly elevated risk (HR, 1.23; 95% CI, 0.97–1.56) compared with women who never reported a diagnosis of depression or antidepressant medication use.

 

Conclusions—Our results suggest that depression is associated with a moderately increased risk of subsequent stroke.

[Altostrata]

E-mail to krexrode@partners.org:

 

From the paper, available at http://stroke.ahajournals.org/content/early/2011/08/11/STROKEAHA.111.617043.abstract: "Results—During 6 years of follow-up, 1033 incident strokes were documented (538 ischemic, 124 hemorrhagic, and 371 unknown strokes). Having a history of depression was associated with a multivariate-adjusted hazard ratio (HR) of 1.29 (95% confidence interval [CI], 1.13–1.48) for total stroke. Women who used antidepressant medications were at increased risk for stroke, whether they also had a Mental Health Index score [less or equal to] 52 or diagnosed depression (HR, 1.39; 95% CI, 1.15–1.69) or not (HR, 1.31; 95% CI, 1.03–1.67). Furthermore, for each cycle, participants who reported current depression had an increased risk of stroke (HR, 1.41; 95% CI, 1.18–1.67), whereas individuals who only had a history of depression were at nonsignificantly elevated risk (HR, 1.23; 95% CI, 0.97–1.56) compared with women who never reported a diagnosis of depression or antidepressant medication use."

 

The "current depression" group included women treated with antidepressants. Individuals who had only a history of depression (non-medicated) had "nonsignificantly elevated risk."

 

The conclusions go on: "In our study, participants who used ADM were at increased risk, with a 39% increased risk for total stroke with selective serotonin reuptake inhibitors, which is highly similar to the results from the Women’s Health Initiative (HR, 1.45; 95% CI, 1.08–1.97)."

 

Dr. Pan et al appear to have drawn a counterfactual assumption from the statistics found by this study.

 

Truly, one wonders what is going on at partners.org. What will it take to acknowledge the stroke risk of antidepressants? Why is this study being used to whitewash a potentially extremely serious adverse effect?

 

Sincerely,

 

[Altostrata]

 

PS As the caveats in the paper explain, what is so vaguely diagnosed as "depression" may be a synonym for an unhealthy lifestyle, which also leads to increased risk of stroke.

[Baxter]

You go, Alto.

[Rhiannon]

In our study, participants who used ADM were at increased risk, with a 39% increased risk for total stroke with selective serotonin reuptake inhibitors, which is highly similar to the results from the Women’s Health Initiative

 

WOW. Why did nobody ever tell me this? Why is nobody talking about this? 39% increased risk? This is outrageous. If this were any other drug and if this were men, don't you think we'd be hearing about a 39% increased risk of stroke?

 

I'm furious.

[summer]

Very scary.... burying my head and not going to think about it tho. We can only do the best we can with this day!

[Altostrata]

Funny, I just posted about this on Thought Broadcast.

 

I agree this is outrageous, but this study got glossed over because its authors attributed the increased stroke risk to depression rather than the antidepressants, even though the unmedicated depressed group had normal stroke risk.

 

I really don't understand how they could come to that conclusion, but Harvard psychiatry was involved, so maybe that explains it.

[Barbarannamated]

Related:

 

Cerebral vasoconstriction and stroke after use of serotonergic drugs.

Singhal AB, Caviness VS, Begleiter AF, Mark EJ, Rordorf G, Koroshetz WJ.

Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.

 

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=11781419

 

"Serotonin (5-hydroxytryptamine) is a potent vasoconstrictor amine. The authors report three patients who developed thunderclap headache, reversible cerebral arterial vasoconstriction, and ischemic strokes (i.e., the Call-Fleming syndrome). The only cause for vasoconstriction was recent exposure to serotonergic drugs in all patients, and to pseudoephedrine in one patient. These cases, and the literature, suggest that the use of serotonin-enhancing drugs can precipitate a cerebrovascular syndrome due to reversible, multifocal arterial narrowing."

[Altostrata]

Also see this study -- link embedded in article at http://www.medpagetoday.com/Cardiology/Strokes/35387

 

Hackam DG, Mrkobrada M "Selective serotonin reuptake inhibitors and brain hemorrhage. A meta-analysis" Neurology 2012; 79: 1862-1865.