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October 19, 2012 — A new study published in the journal Neurology has linked the use of SSRI antidepressants to an increased risk of bleeding in the brain, which can cause stroke. Because these strokes are relatively rare to begin with, the increased risk is still low. However, the study adds to a growing amount of research linking antidepressants to severe bleeding, including gastrointestinal bleeding.

SSRI antidepressants (“selective serotonin reuptake inhibitors”) are the most popular class of antidepressants in the U.S., and include drugs like Prozac (fluoxetine), Zoloft (sertraline), Celexa (citalopram), Lexapro (escitalopram), and more.

The Canadian researchers reviewed existing medical literature for studies on antidepressants, bleeding, and stroke. They conducted a meta-analysis of the combined results from 16 studies, which included 506,411 patients. They found that people who used SSRIs were 51% more likely to have an intra-cranial hemorrhagic stroke (bleeding in the skull) and 42% more likely to have an intra-cerebral hemorrhagic stroke (bleeding within the brain itself) compared to people who did not take SSRI antidepressants.

Studies have linked SSRI antidepressants to a blood-thinning effect in the first few months while a patient is using the drug. This could be significant, especially for a person who is also taking a blood-thinning medication (such as Pradaxa or warfarin), which also have a risk of bleeding. The researchers found a 56% increased risk of stroke among patients taking an SSRI plus a blood-thinner, compared to people on blood-thinners alone.

The risk of bleeding and stroke may also be higher for people who have had these types of strokes in the past or have risk factors. The researchers wrote:

“We believe clinicians might consider alternate classes of antidepressants in patients with intrinsic risk factors for intracerebral hemorrhage, such as those receiving long-term oral anticoagulation, individuals with previous intracranial bleeding, and patients with cerebral amyloid angiopathy or severe alcohol abuse.”

The authors of the study cautioned that the research should not deter people from using an SSRI if they have a clinical reason, because the actual increased risk of stroke is relatively small. However, the study emphasizes the importance of selecting antidepressants carefully for patients with certain risk factors for bleeding.

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