antidepressantsMedical Condition

Antidepressants and Painkillers Could Raise Risk of Stroke

According to a new analysis, some antidepressants are linked to a slightly increased risk of bleeding stroke.

In one of the studies, Korean researchers found that of more than 4 million people prescribed the first-time antidepressant; those who also used non-steroidal anti-inflammatory drugs (NSAIDs) had a higher risk of intracranial hemorrhage within the next month.

Intracranial hemorrhage is bleeding under the skull that can lead to permanent brain damage or death.

Drugs that are commonly used in clinical practice may confer a slight increase in stroke risk. Stroke risk is associated with nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, vitamin E, statins, hormone replacement therapy (HRT), and testosterone replacement therapy. Although these drugs have a small risk of stroke, there is a risk of stroke.

The findings on NSAIDs, which include over-the-counter pain relievers such as aspirin, ibuprofen (Motrin, Advil) and naproxen (Aleve), led to the U.S. Food and Drug Administration, strengthened the warning labels on some NSAIDs, emphasizing that the drugs can raise the risk of heart attack and stroke.

Stroke strikes about 795,000 Americans each year, according to the American Stroke Association, and as far as the new link to brain bleeding in antidepressant users, there are still many questions that remain unanswered.

In another study, Researchers looked at 16 published studies that included more than 500,000 people, with the primary focus on the popular antidepressants known as SSRIs (selective serotonin reuptake inhibitors).

Some common selective serotonin reuptake inhibitors include: Celexa (citalopram),  Lexapro(escitalopram),  Paxil (paroxetine), Prozac (fluoxetine), Viibryd (vilazodone), and Zoloft (sertraline).

For most people, the risk of stroke linked with these drugs is low, and in overall, the additional bleeding risk is about 1 per 10,000 people treated with SSRIs in a year.

The studies evaluated found a link, not a cause and effect, and as for those who already have risk factors for bleeding stroke, the risk is higher.

Antidepressants

About 40% of patients with stroke have depression after their stroke, and many of them are on antidepressants. Research has suggested that selective serotonin reuptake inhibitors (SSRIs) might help promote recovery after stroke.  However, any time you use one of these SSRIs as an antidepressant, there seem to be a higher risk of suicide or having suicidal thoughts.

SSRIs may enhance motor and cognitive recovery, but they may have antiplatelet properties, and just as caution has been recommended when combining aspirin and NSAIDs, an additive effect may be at play with SSRIs.

Combination of SSRIs with aspirin or NSAIDs may further increase the risk of bleeding, and you may be potentiating the increase in a brain hemorrhage.

Drugs That May Increase the Risk of Stroke

Statins

Data from the SPARCL trial, which was the study that led to the recommendation of statins for recurrent stroke prevention, showed that several patient subgroups had a higher risk of a brain hemorrhage.

Such group includes those who had a hemorrhage at entry into the study, men, those who were older, and those with high or poorly controlled blood pressure.

Vitamin E

Data from a meta-analysis of Vit.E show that with 300 to 900 IU of vitamin E, the total incidence of stroke was slightly reduced, but not to a statistically significant degree. However,

  • hemorrhagic stroke was increased by about 22%,
  • Ischemic stroke in the stratified analysis was reduced by about 10%.

This showed that by reducing ischemic stroke, you increase hemorrhagic stroke. But the absolute effects are very small (0.8 more hemorrhagic strokes, 2.1 fewer ischemic strokes per 1,000 treated).

Zoloft (Sertraline)

Sertraline is known as a selective serotonin reuptake inhibitor (SSRI), and may improve your mood, sleep, appetite, and energy level and may help restore your interest in daily living. It may also decrease fear, anxiety, unwanted thoughts, and the number of panic attacks. It works by helping to restore the balance of a certain natural substance (serotonin) in the brain.

However, Side Effects include:

  • Nausea,
  • dizziness,
  • drowsiness,
  • dry mouth,
  • loss of appetite,
  • increased sweating,
  • Diarrhea or stomach upset,
  • Trouble sleeping may occur.

Unlikely but serious side effects include:

  • Easy bruising/bleeding,
  • decreased interest in sex,
  • a decrease in sexual ability (ejaculation delay),
  • muscle cramps/weakness,
  • shaking (tremor), and
  • Unusual weight loss.
  • Serious black/bloody stools,
  • vomit that looks like coffee grounds,
  • Eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night) and blurred vision.

Furthermore, this medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin.

So, tell your doctor or pharmacist of all the drugs you take and get medical help right away if any of these rare symptoms occur.

Hormone Replacement Therapy

Hormone Replacement Therapy (HRT) is making a comeback. The Women’s Health Initiative found that in healthy postmenopausal women taking estrogen plus progestin, the incidence of coronary artery disease was increased significantly, as were those for breast cancer, stroke, and pulmonary embolism.

Colorectal cancer and hip fracture were reduced, while probable dementia and cognitive decline were increased. For women who received conjugated equine estrogen only, there were no statistically significant benefits of taking postmenopausal hormone replacement therapy on any of these cardiovascular, cancers, or hip fracture outcome

Antidepressants and Stroke Risk: Study Details

A team of researchers searched the medical literature to find studies on SSRIs and brain hemorrhage and discovered that studies on their link with brain bleeding have mixed findings.

These group f researchers found that people taking SSRIs were about 40% or 50% more likely than those not on the drugs to have strokes known as intracranial hemorrhages or intracerebral hemorrhages.

These types of strokes are rare, but the statistic does not translate to a high actual or “absolute” risk.

The researchers found that the risk of stroke found for those taking SSRIs who already had risk factors for strokes, such as being on anticoagulants or blood thinners, was higher.

Those on SSRIs, who are already at risk for stroke or are already taking blood thinners or anti-platelet drugs, should talk to their doctor, to know the most appropriate class of antidepressants they should take.

SSRIs slow down the rate of blood clot formation, and this is thought to explain the link between antidepressants and hemorrhagic stroke risk.

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