Antidepressant treatment and worsening white matter on serial cranial magnetic resonance imaging in the elderly

The cardiovascular health study

David C. Steffens, Hyoju Chung, K. Ranga R Krishnan, W. T. Longstreth, Michelle C Carlson, Gregory L. Burke

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE - In some studies, late life depression is associated with white matter lesions on MRI. The effect of different classes of antidepressants on progression of white matter lesions is unknown. Selective serotonergic reuptake inhibitors (SSRIs) may decrease platelet aggregation. We hypothesized that Cardiovascular Health Study participants taking SSRIs would less often have worsening white matter on serial MRI than participants not on antidepressants. METHODS - Among 1826 participants who were not using an antidepressant at initial MRI scan, we examined the association of worsening in white matter grade from initial to follow-up MRI scans, 5 years apart on average, and antidepressant use between the scans. Logistic regression models were used, controlling for a variety of potential confounding variables. RESULTS - Use of any antidepressant during the period of study was associated with worsening white matter. In a multivariable model, risk was slightly increased, not reduced, with use of serotonergic agents (OR 1.36, 95% CI 0.87 to 2.12) and was significantly increased with the use of tricyclic antidepressants (OR 1.77, 95% CI 1.07 to 2.94). CONCLUSIONS - The association between worsening white matter and use of tricyclic antidepressants was an unexpected finding that may relate to indications for use other than depression or to side effects such as hypotension. Protection against worsening was not seen with use of serotonergic agents.

Original languageEnglish (US)
Pages (from-to)857-862
Number of pages6
JournalStroke
Volume39
Issue number3
DOIs
StatePublished - Mar 2008

Fingerprint

Antidepressive Agents
Magnetic Resonance Imaging
Health
Serotonin Agents
Tricyclic Antidepressive Agents
Therapeutics
Logistic Models
Confounding Factors (Epidemiology)
Platelet Aggregation
Hypotension
White Matter

Keywords

  • Antidepressant
  • Depression
  • Neuroimaging
  • Serotonin
  • White matter

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)
  • Medicine(all)

Cite this

Antidepressant treatment and worsening white matter on serial cranial magnetic resonance imaging in the elderly : The cardiovascular health study. / Steffens, David C.; Chung, Hyoju; Krishnan, K. Ranga R; Longstreth, W. T.; Carlson, Michelle C; Burke, Gregory L.

In: Stroke, Vol. 39, No. 3, 03.2008, p. 857-862.

Research output: Contribution to journalArticle

Steffens, David C. ; Chung, Hyoju ; Krishnan, K. Ranga R ; Longstreth, W. T. ; Carlson, Michelle C ; Burke, Gregory L. / Antidepressant treatment and worsening white matter on serial cranial magnetic resonance imaging in the elderly : The cardiovascular health study. In: Stroke. 2008 ; Vol. 39, No. 3. pp. 857-862.
@article{00f10ff3a246497ea96f3551eded3adf,
title = "Antidepressant treatment and worsening white matter on serial cranial magnetic resonance imaging in the elderly: The cardiovascular health study",
abstract = "BACKGROUND AND PURPOSE - In some studies, late life depression is associated with white matter lesions on MRI. The effect of different classes of antidepressants on progression of white matter lesions is unknown. Selective serotonergic reuptake inhibitors (SSRIs) may decrease platelet aggregation. We hypothesized that Cardiovascular Health Study participants taking SSRIs would less often have worsening white matter on serial MRI than participants not on antidepressants. METHODS - Among 1826 participants who were not using an antidepressant at initial MRI scan, we examined the association of worsening in white matter grade from initial to follow-up MRI scans, 5 years apart on average, and antidepressant use between the scans. Logistic regression models were used, controlling for a variety of potential confounding variables. RESULTS - Use of any antidepressant during the period of study was associated with worsening white matter. In a multivariable model, risk was slightly increased, not reduced, with use of serotonergic agents (OR 1.36, 95{\%} CI 0.87 to 2.12) and was significantly increased with the use of tricyclic antidepressants (OR 1.77, 95{\%} CI 1.07 to 2.94). CONCLUSIONS - The association between worsening white matter and use of tricyclic antidepressants was an unexpected finding that may relate to indications for use other than depression or to side effects such as hypotension. Protection against worsening was not seen with use of serotonergic agents.",
keywords = "Antidepressant, Depression, Neuroimaging, Serotonin, White matter",
author = "Steffens, {David C.} and Hyoju Chung and Krishnan, {K. Ranga R} and Longstreth, {W. T.} and Carlson, {Michelle C} and Burke, {Gregory L.}",
year = "2008",
month = "3",
doi = "10.1161/STROKEAHA.107.498097",
language = "English (US)",
volume = "39",
pages = "857--862",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Antidepressant treatment and worsening white matter on serial cranial magnetic resonance imaging in the elderly

T2 - The cardiovascular health study

AU - Steffens, David C.

AU - Chung, Hyoju

AU - Krishnan, K. Ranga R

AU - Longstreth, W. T.

AU - Carlson, Michelle C

AU - Burke, Gregory L.

PY - 2008/3

Y1 - 2008/3

N2 - BACKGROUND AND PURPOSE - In some studies, late life depression is associated with white matter lesions on MRI. The effect of different classes of antidepressants on progression of white matter lesions is unknown. Selective serotonergic reuptake inhibitors (SSRIs) may decrease platelet aggregation. We hypothesized that Cardiovascular Health Study participants taking SSRIs would less often have worsening white matter on serial MRI than participants not on antidepressants. METHODS - Among 1826 participants who were not using an antidepressant at initial MRI scan, we examined the association of worsening in white matter grade from initial to follow-up MRI scans, 5 years apart on average, and antidepressant use between the scans. Logistic regression models were used, controlling for a variety of potential confounding variables. RESULTS - Use of any antidepressant during the period of study was associated with worsening white matter. In a multivariable model, risk was slightly increased, not reduced, with use of serotonergic agents (OR 1.36, 95% CI 0.87 to 2.12) and was significantly increased with the use of tricyclic antidepressants (OR 1.77, 95% CI 1.07 to 2.94). CONCLUSIONS - The association between worsening white matter and use of tricyclic antidepressants was an unexpected finding that may relate to indications for use other than depression or to side effects such as hypotension. Protection against worsening was not seen with use of serotonergic agents.

AB - BACKGROUND AND PURPOSE - In some studies, late life depression is associated with white matter lesions on MRI. The effect of different classes of antidepressants on progression of white matter lesions is unknown. Selective serotonergic reuptake inhibitors (SSRIs) may decrease platelet aggregation. We hypothesized that Cardiovascular Health Study participants taking SSRIs would less often have worsening white matter on serial MRI than participants not on antidepressants. METHODS - Among 1826 participants who were not using an antidepressant at initial MRI scan, we examined the association of worsening in white matter grade from initial to follow-up MRI scans, 5 years apart on average, and antidepressant use between the scans. Logistic regression models were used, controlling for a variety of potential confounding variables. RESULTS - Use of any antidepressant during the period of study was associated with worsening white matter. In a multivariable model, risk was slightly increased, not reduced, with use of serotonergic agents (OR 1.36, 95% CI 0.87 to 2.12) and was significantly increased with the use of tricyclic antidepressants (OR 1.77, 95% CI 1.07 to 2.94). CONCLUSIONS - The association between worsening white matter and use of tricyclic antidepressants was an unexpected finding that may relate to indications for use other than depression or to side effects such as hypotension. Protection against worsening was not seen with use of serotonergic agents.

KW - Antidepressant

KW - Depression

KW - Neuroimaging

KW - Serotonin

KW - White matter

UR - http://www.scopus.com/inward/record.url?scp=41249089028&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=41249089028&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.107.498097

DO - 10.1161/STROKEAHA.107.498097

M3 - Article

VL - 39

SP - 857

EP - 862

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 3

ER -