Research Reports - Risk of stroke among older antidepressant users with traumatic brain injury

J Head Trauma Rehabil. 2016 Mar 28. [Epub ahead of print]

Khokhar B(1), Simoni-Wastila L, Albrecht JS.

OBJECTIVE: To estimate the risk of stroke associated with new antidepressant use
among older adults with traumatic brain injury (TBI).
PARTICIPANTS: A total of 64 214 Medicare beneficiaries aged 65 years or older
meeting inclusion criteria and hospitalized with a TBI during 2006 to 2010.
DESIGN: New user design. Generalized estimating equations were used to estimate
the relative risks (RRs) of stroke.
MAIN MEASURES: Primary exposure was new antidepressant use following TBI
identified through Medicare part D claims. The primary outcome was stroke
following TBI. Ischemic and hemorrhagic strokes were secondary outcomes.
RESULTS: A total of 20 859 (32%) beneficiaries used an antidepressant at least
once following TBI. Selective serotonin reuptake inhibitors accounted for the
majority of antidepressant use. Selective serotonin reuptake inhibitor use was
associated with an increased risk of hemorrhagic stroke (RR, 1.26; 95% confidence
interval [CI], 1.06-1.50) but not ischemic stroke (RR, 1.04; 95% CI, 0.94-1.15).
The selective serotonin reuptake inhibitors escitalopram (RR, 1.33; 95% CI,
1.02-1.74) and sertraline (RR, 1.46; 95% CI, 1.10-1.94) were associated with an
increase in the risk of hemorrhagic stroke.
CONCLUSION: Findings from this study will aid prescribers in choosing appropriate
antidepressants to treat depression in older adults with TBI. 

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