TY - JOUR
T1 - Initiation of antidepressant medication and risk of incident stroke
T2 - using the Adult Changes in Thought cohort to address time-varying confounding
AU - Glymour, M. Maria
AU - Gibbons, Laura E.
AU - Gilsanz, Paola
AU - Gross, Alden L.
AU - Mez, Jesse
AU - Brewster, Paul W.
AU - Marden, Jessica
AU - Zahodne, Laura B.
AU - Nho, Kwangsik
AU - Hamilton, Jamie
AU - Li, Gail
AU - Larson, Eric B.
AU - Crane, Paul K.
N1 - Funding Information:
This work was supported by the Advanced Psychometrics Methods in Cognitive Aging Research ( R13 AG030995 ) by the National Institutes of Health ( K99 AG047963 for L.B.Z., F31 HL112613 for P.A.G., T32 MH017119 for P.A.G., R01 LM012535 and R03 AG054936 for K.N., K23 AG046377 for J.B.M., P50 AG05136 for L.E.G.) and by the Yerby Postdoctoral Fellowship Program to P.A.G. Data collection was supported by U01 AG006781, which also supported the efforts of P.K.C. and E.B.L.
Publisher Copyright:
© 2019
PY - 2019/7
Y1 - 2019/7
N2 - Purpose: Depression strongly predicts stroke incidence, suggesting that treating depression may reduce stroke risk. Antidepressant medications, however, may increase stroke risk via direct pathways. Previous evidence on antidepressant medication and stroke incidence is mixed. We evaluated associations between antidepressant use and incident stroke. Methods: For 2302 Adult Changes in Thought cohort participants with no stroke at study entry, we characterized antidepressant use from pharmacy records, biennial depressive symptoms with a 10-item Centers for Epidemiologic Study–Depression scale, and incident strokes from ICD codes. We used discrete-time survival models with inverse probability weighting to compare stroke risk associated with filling antidepressant prescriptions and by medication category: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors, or other. Results: Over an average 8.4-year follow-up, 441 incident strokes occurred. Filling antidepressant medications 3+ times versus 0–2 times predicted 35% increased odds of stroke (OR = 1.35; 95% CI: 0.98, 1.66). Use of TCAs was associated with stroke onset (OR per 10 fills = 1.28; CI: 1.04, 1.57), but use of selective serotonin reuptake inhibitors (OR = 0.98; CI: 0.80, 1.20) or other antidepressants (OR = 0.99; CI: 0.67, 1.45) was not. Conclusions: Although patients who received antidepressant medication were at higher risk of stroke, this association appeared specific to TCA prescriptions.
AB - Purpose: Depression strongly predicts stroke incidence, suggesting that treating depression may reduce stroke risk. Antidepressant medications, however, may increase stroke risk via direct pathways. Previous evidence on antidepressant medication and stroke incidence is mixed. We evaluated associations between antidepressant use and incident stroke. Methods: For 2302 Adult Changes in Thought cohort participants with no stroke at study entry, we characterized antidepressant use from pharmacy records, biennial depressive symptoms with a 10-item Centers for Epidemiologic Study–Depression scale, and incident strokes from ICD codes. We used discrete-time survival models with inverse probability weighting to compare stroke risk associated with filling antidepressant prescriptions and by medication category: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors, or other. Results: Over an average 8.4-year follow-up, 441 incident strokes occurred. Filling antidepressant medications 3+ times versus 0–2 times predicted 35% increased odds of stroke (OR = 1.35; 95% CI: 0.98, 1.66). Use of TCAs was associated with stroke onset (OR per 10 fills = 1.28; CI: 1.04, 1.57), but use of selective serotonin reuptake inhibitors (OR = 0.98; CI: 0.80, 1.20) or other antidepressants (OR = 0.99; CI: 0.67, 1.45) was not. Conclusions: Although patients who received antidepressant medication were at higher risk of stroke, this association appeared specific to TCA prescriptions.
KW - Antidepressant medication
KW - Confounding by indication
KW - Depression
KW - Pharmacoepidemiology
KW - Stroke
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U2 - 10.1016/j.annepidem.2019.04.010
DO - 10.1016/j.annepidem.2019.04.010
M3 - Article
C2 - 31200987
AN - SCOPUS:85067016202
SN - 1047-2797
VL - 35
SP - 42-47.e1
JO - Annals of epidemiology
JF - Annals of epidemiology
ER -