Selective Serotonin Reuptake Inhibitors and Risk of Cerebral Bleeding

See related article, p 1951.Selective serotonin reuptake inhibitors (SSRIs) are used commonly to treat poststroke depression.1,2 They are also being evaluated in clinical trials for their effectiveness in facilitating functional recovery after stroke.3,4However, observational studies suggest that SSRIs are associated with several adverse outcomes in older people (aged >65 years), including an increased risk of all-cause mortality (10.61% per year with SSRI versus 7.04% per year with no antidepressant; hazard ratio [HR], 1.54, 95% confidence interval [CI], 1.48–1.59), stroke (2.61% versus 2.23%; HR, 1.17; 95% CI, 1.10–1.26), myocardial infarction (1.15% versus 1.00%; HR, 1.15; 95% CI, 1.04–1.27), epileptic seizures (0.38% versus 0.21%; HR, 1.83; 95% CI, 1.49–2.26), falls (5.67% versus 3.46%; HR, 1.66, 95% CI, 1.58–1.73), fractures (2.74% versus 1.76%; HR, 1.58; 95% CI, 1.48–1.68), hyponatremia (0.44% versus 0.29%; HR, 1.52; 95% CI, 1.33–1.75), and upper gastrointestinal bleeding (0.51% versus 0.42%; HR, 1.22; 95% CI, 1.07–1.40).5Furthermore, a meta-analysis of 16 observational studies involving 506 411 participants reported that SSRIs are also associated with an increased risk of intracerebral hemorrhage (ICH; adjusted risk ratio, …