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Pan, 2011 Depression and Incident Stroke in Women


Altostrata
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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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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You go, Alto.

 

1989 - 1992 Parnate* 

1992-1998 Paxil - pooped out*, oxazapam, inderal

1998 - 2005 Celexa - pooped out* klonopin, oxazapam, inderal

*don't remember doses

2005 -2007   Cymbalta 60 mg oxazapam, inderal, klonopin

Started taper in 2007:

CT klonopin, oxazapam, inderal (beta blocker) - 2007

Cymbalta 60mg to 30mg 2007 -2010

July 2010 - March 2018 on hiatus due to worsening w/d symptoms, which abated and finally disappeared. Then I stalled for about 5 years because I didn't want to deal with W/D.

March 2018 - May 2018 switch from 30mg Cymbalta to 20mg Celexa 

19 mg Celexa October 7, 2018

18 mg Celexa November 5, 2018

17 mg Celexa  December 2, 2019

16 mg Celexa January 6, 2018 

15 mg Celexa March 7, 2019

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12.2 Celexa December 28, 2020

12 mg Celexa March 2021

 

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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.

Started on Prozac and Xanax in 1992 for PTSD after an assault. One drug led to more, the usual story. Got sicker and sicker, but believed I needed the drugs for my "underlying disease". Long story...lost everything. Life savings, home, physical and mental health, relationships, friendships, ability to work, everything. Amitryptiline, Prozac, bupropion, buspirone, flurazepam, diazepam, alprazolam, Paxil, citalopram, lamotrigine, gabapentin...probably more I've forgotten. 

Started multidrug taper in Feb 2010.  Doing a very slow microtaper, down to low doses now and feeling SO much better, getting my old personality and my brain back! Able to work full time, have a full social life, and cope with stress better than ever. Not perfect, but much better. After 23 lost years. Big Pharma has a lot to answer for. And "medicine for profit" is just not a great idea.

 

Feb 15 2010:  300 mg Neurontin  200 Lamictal   10 Celexa      0.65 Xanax   and 5 mg Ambien 

Feb 10 2014:   62 Lamictal    1.1 Celexa         0.135 Xanax    1.8 Valium

Feb 10 2015:   50 Lamictal      0.875 Celexa    0.11 Xanax      1.5 Valium

Feb 15 2016:   47.5 Lamictal   0.75 Celexa      0.0875 Xanax    1.42 Valium    

2/12/20             12                       0.045               0.007                   1 

May 2021            7                       0.01                  0.0037                1

Feb 2022            6                      0!!!                     0.00167               0.98                2.5 mg Ambien

 

I'm not a doctor. Any advice I give is just my civilian opinion.

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

 

 

Charter Member 2011

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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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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  • 1 year later...

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."

Pristiq tapered over 8 months ending Spring 2011 after 18 years of polydrugging that began w/Zoloft for fatigue/general malaise (not mood). CURRENT: 1mg Klonopin qhs (SSRI bruxism), 75mg trazodone qhs, various hormonesLitigation for 11 years for Work-related injury, settled 2004. Involuntary medical retirement in 2001 (age 39). 2012 - brain MRI showing diffuse, chronic cerebrovascular damage/demyelination possibly vasculitis/cerebritis. Dx w/autoimmune polyendocrine failure.<p>2013 - Dx w/CNS Sjogren's Lupus (FANA antibodies first appeared in 1997 but missed by doc).

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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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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