Antidepressants strongly inhibiting serotonin reuptake may be associated with a small reduction in the rate of ischemic stroke compared with weak reuptake inhibitors, according to a study published online in Neurology.

Antonios Douros, M.D., Ph.D., from McGill University in Montreal, and colleagues conducted a cohort study using the U.K. Clinical Practice Research Datalink and considering new users of selective serotonin reuptake inhibitors (SSRIs; 868,755 individuals) or third-generation antidepressants (69,633 individuals) aged 18 years or older between 1995 and 2014. Each case of a first ischemic stroke or myocardial infarction (MI) identified during follow-up was matched with up to 30 controls based on age, sex, calendar time, and duration of follow-up.

The researchers identified 15,860 cases of ischemic stroke and 8,626 cases of MI; these cases were matched to 473,712 and 258,022 controls, respectively. Current use of strong inhibitors was associated with a decreased rate of ischemic stroke compared with current use of weak inhibitors of serotonin reuptake (rate ratio, 0.88; 95 percent confidence interval, 0.80 to 0.97); in some sensitivity analyses, the effect size was smaller. The rate of MI was similar with current use of strong and weak inhibitors (rate ratio, 1.00; 95 percent confidence interval, 0.87 to 1.15).

"Given the modest effect size, choice of antidepressant treatment should be based on effectiveness and adverse events such as weight gain rather than the risk of arterial ischemic events," the authors write.

One author disclosed financial ties to the biopharmaceutical industry.

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