Higher Risk Of Recurring Brain Bleeds Linked to SSRI Antidepressant Side Effects

Individuals who are prescribed antidepressants after suffering a stroke may face a higher risk of suffering a brain bleed later, according to the findings of new research.

In a study published late last month in the medical journal JAMA Neurology, Massachusetts General Hospital researchers concluded selective serotonin reuptake inhibitor (SSRI) drugs can help alleviate severe depression after suffering a stroke, but side effects of the antidepressants also increase the risk of brain bleeds.

Researchers conducted a longitudinal cohort study focusing on intracerebral hemorrhage (ICH) survivors with depression from January 2006 to December 2017. The ICH cohort study included 1,200 adults discharged after being hospitalized and treated after suffering a stroke. Patients were followed for 54 months.

Taking SSRIs, such as Paxil or Zoloft, was linked to reduced depression after a stroke caused by brain bleeds. However, SSRIs were also linked to increased risk of ICH recurrence, or having another brain bleed.

The increased risk of brain bleeds from the SSRI antidepressants was especially heightened for patients with preexisting clinical, genetic, or neuroimaging risk factors for hemorrhagic stroke. On average, patients were 71 years old.

The risk of brain bleed was increased compared with all other brain bleed survivors who did not use SSRI antidepressants.

Depression is common following a stroke, so doctors often consider treating patients with antidepressants. SSRIs are considered a first line treatment after stroke, but for patients who have a higher risk of brain bleeds after stroke, SSRIs may not be the best course of treatment and may lead to another hemorrhagic bleed in the brain, the researchers determined.

A prior study published in 2016 also indicated SSRI antidepressants were linked to an increased risk of brain bleeds, especially among patients taking blood thinners like Warfarin or Xarelto. Current use of SSRIs was linked to a 25% increased risk of brain bleed compared to other types antidepressants.

Doctor’s must weigh the decision to treat depression among stroke survivors with SSRIs against the increased risk of the patient suffering another brain bleed, the researchers warned. The benefits of improved depression may not outweigh those risks in many cases. Doctors should especially be cautious about giving patients SSRIs if they have a history of ICH.

“Selective serotonin reuptake inhibitor exposure after ICH is associated with both improvement in depressive symptoms and increased risk of recurrent hemorrhagic stroke,” the researchers determined. “Clinical history, neuroimaging data, and genetic biomarkers may help to identify survivors of ICH more likely to safely tolerate SSRI use.”