Department of Psychiatry, Far Eastern Memorial Hospital, Taipei, Taiwan.
Am J Psychiatry. 2011 May;168(5):511-21. doi: 10.1176/appi.ajp.2010.10071064. Epub 2011 Mar 15.
The authors sought to assess the risk of cerebrovascular events associated with use of antidepressant medications.
The authors conducted a case-crossover study of 24,214 patients with stroke enrolled in the National Health Insurance Research Database in Taiwan from 1998 to 2007. The authors compared the rates of antidepressant use during case and control time windows of 7, 14, and 28 days. Adjustments were made for time-dependent variables, such as health system utilization and proposed confounding medications. Stratified analyses were performed for valuing the interaction between the stroke risk of antidepressant use and age, sex, presence of mood disorder, stroke type, severity of chronic illness, and duration of antidepressant treatment. A conditional logistic regression model was used to determine the odds of antidepressant use during case time windows.
The adjusted odds ratio of stroke risk with antidepressant exposure was 1.48 (95% confidence interval=1.37-1.59) using 14-day time windows. Stroke risk was negatively associated with the number of antidepressant prescriptions reported. Use of antidepressants with high inhibition of the serotonin transporter was associated with a greater risk of stroke than use of other types of antidepressants.
These findings suggest that antidepressant use may be associated with an increased risk of stroke. However, the underlying mechanisms remain unclear.
作者旨在评估与使用抗抑郁药物相关的脑血管事件风险。
作者对 2007 年在台湾的国家健康保险研究数据库中登记的 24214 名中风患者进行了病例交叉研究。作者比较了病例和对照时间窗（7、14 和 28 天）期间使用抗抑郁药物的比率。调整了与时间相关的变量，如卫生系统的利用情况和拟议的混杂药物。对年龄、性别、情绪障碍、中风类型、慢性病严重程度和抗抑郁药物治疗时间等因素之间的抗抑郁药物使用与中风风险的交互作用进行了分层分析。采用条件逻辑回归模型确定病例时间窗内使用抗抑郁药物的比值比。
使用 14 天时间窗时，抗抑郁药物暴露后中风风险的调整比值比为 1.48（95%置信区间为 1.37-1.59）。中风风险与报告的抗抑郁药物处方数量呈负相关。使用对 5-羟色胺转运体有高度抑制作用的抗抑郁药与其他类型的抗抑郁药相比，中风风险更高。
这些发现表明，抗抑郁药物的使用可能与中风风险增加有关。然而，其潜在机制尚不清楚。
