Antidepressants Increase Stroke in Older Women, Depressed or Not

[Altostrata]

Medpage Today curiously misrepresents this study as finding

 

Depression Increases Stroke Risk in Older Women

 

By Nancy Walsh MedPage Today August 11, 2011

 

....

Among a cohort of more than 80,000 women followed for a six-year period, those with a history of depression had a 29% greater risk of stroke than those without depression, according to Kathryn M. Rexrode, MD, of Harvard Medical School in Boston, and colleagues.

 

Additionally, those with current depression had a 41% greater risk of stroke, while those with only a history of depression had a 23% greater risk, compared with women who never reported a diagnosis of depression or antidepressant medication use, according to the study published online in Stroke: Journal of the American Heart Association.

 

Those data were adjusted for age, marital status, parental history of myocardial infarction, ethnicity, physical activity level, body mass index, alcohol consumption, smoking status, menopausal status, postmenopausal hormone therapy, current aspirin use, current multivitamin use, and Dietary Approaches to Stop Hypertension dietary score, as well as history of hypertension, hypercholesterolemia, diabetes, cancer, and heart diseases.

 

Rexrode and colleagues had previously found that depression and use of antidepressant medication were linked with sudden death and fatal coronary heart disease (J Am Coll Cardiol 2009;53:950–958).

 

....

To explore the impact of depression on stroke in older women -- ages 54 to 79 -- the researchers analyzed data from the longitudinal Nurses' Health Study, in which participants completed biennial questionnaires on their health.

 

In the questionnaire sent to participants in 2000, the self-reported prevalence of depression was 22.3%.

 

Depression status was considered positive if there had ever been a physician diagnosis of depression, if antidepressant drugs were used routinely, or if the five-item Mental Health Index (MDI-5) score was at or below 52. Depressive symptoms were assessed in 1992, 1996, and 2000.

 

Women reporting a history of depression tended to be younger than those without such a history, as well as to be unmarried, smokers, and to have a higher body mass index and other comorbidities.

 

Among the 1,033 incident strokes reported between 2000 and 2006, 538 were ischemic, 124 were hemorrhagic, and the remainder were of unknown type.

 

In the adjusted model, the use of antidepressant medications in women who had a history of physician-diagnosed depression or a MDI-5 score of 52 or less was associated with an increased risk of stroke (HR 1.39, 95% CI 1.15 to 1.69).

 

In the same model, the HR dropped to 1.18 (95% CI, 0.96 to 1.45) for women with a history of physician-diagnosed depression or a MDI-5 score of 52 or less, but not taking medication.

 

The HR rose to 1.31 (95% CI 1.03 to 1.67) for women who used antidepressants, but did not have a diagnosis of depression or a clinical score below the cutoff.

 

The selective serotonin reuptake inhibitors -- the largest use category -- increased the risk by almost 40% (HR 1.39, 95% CI 1.13 to 1.72). The risk for other medication types was only 1.14 (95% CI 0.82 to 1.58).

 

There has been considerable interest recently in the potential for antidepressants to contribute to cardiovascular disease, possibly through weight gain, hypertension, and inflammation.

 

But reports have been inconsistent, and Rexrode's group noted that the use of antidepressants may reflect the severity of depression, rather than representing a cause of heart disease or stroke.

 

They called for further research on antidepressants and cardiovascular outcomes, emphasizing doses and duration of treatment.

 

Aside from neuroendocrine mechanisms that might contribute to cardiovascular disease in depressed women, the researchers noted that the clinical manifestations of depression in an older population might relate to subclinical vascular disease.

 

Further contributing to stroke could be negative health factors such as smoking, lack of physical activity, and obesity.

 

Nonetheless, they concluded that their data "provide additional evidence that depression is associated with a moderately increased risk of incident stroke."

Limitations of the study included its fairly homogeneous white population, the possibility of selection bias, and self-report of depression.

 

The study was supported by the National Institutes of Health and the National Alliance for Research on Schizophrenia and Depression.

 

The authors reported no financial disclosures.

 

Primary source: Stroke

 

Source reference:

Pan A, et al "Depression and incident stroke in women" Stroke 2011; DOI: 10.1161/strokeaha.111.617043.

 

 

http://www.medpagetoday.com/Cardiology/Strokes/28012?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=377937

[cinephile]

The selective serotonin reuptake inhibitors -- the largest use category -- increased the risk by almost 40% (HR 1.39, 95% CI 1.13 to 1.72). The risk for other medication types was only 1.14 (95% CI 0.82 to 1.58).

Paging Peter Kramer! Paging Dr. Kramer! Doctor, can you please explain your claim below, as published in your New York Times article, "In Defense of Antidepressants?"

 

In stroke patients, antidepressants look like a tonic for brain health.

Dr Kramer? Doctor?

[Altostrata]

Sent this letter to the doctor responsible for reviewing the article for MedPage Today.

 

Dr. Jasmer --

 

You are listed as a reviewer of this story in Medpage Today: Depression Increases Stroke Risk in Older Women, at http://www.medpagetoday.com/Cardiology/Strokes/28012?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&userid=377937

 

The headline is incorrect. The correct headline should read Antidepressants Increase Stroke Risk in Older Women, Depressed or Not.

 

The story states: "The selective serotonin reuptake inhibitors -- the largest use category -- increased the risk by almost 40% (HR 1.39, 95% CI 1.13 to 1.72). The risk for other medication types was only 1.14 (95% CI 0.82 to 1.58)."

 

It's truly unfortunate that psychiatric research has misrepresented the risk of antidepressants and the health dangers of depression to support marketing of the medications. This has cast a cloud over the credibility of medical research in general and caused a great deal of patient injury.

 

It's inexcusable that bad reporting further exaggerates the health risks of depression in the service of selling antidepressants.

 

You may wish to review the article again and correct the headline.

 

Sincerely,

 

[Altostrata]

 

----------------reply-----------------

Thank you for your thoughts on our review. I would strongly suggest that you read the original publication in Stroke by Pan et al.

 

As stated in the Abstract and Conclusions of the original publication, the main conclusion of this research is that "depression is associated with a moderately increased risk of incident stroke."

 

Although the headline may be incorrect (since causation cannot be inferred based upon the study design), the story that we reported is an accurate summary of the original publication.

 

The issue of antidepressant medication is reflected appropriately in the body of the story and was not the main thrust of the story. Again read the original paper.

 

Sorry you find our reporting "bad" but our role is not to further a particular agenda such as your strong feelings over antidepressant medications. We summarized the publication. appropriately in this case.

 

If you have issues with the study design or its conclusions, I'd suggest that you contact Dr. Pan.

 

Best regards,

Dr. Robert Jasmer

 

 

 

So I contacted the authors of the study, see http://survivingantidepressants.org/index.php?/topic/1069-2011-depression-and-incident-stroke-in-women/page__gopid__9378#entry9378