OBJECTIVE

To estimate the risk of stroke associated with new antidepressant use among older adults with traumatic brain injury (TBI).

PARTICIPANTS

A total of 64 214 Medicare beneficiaries aged 65 years or older meeting inclusion criteria and hospitalized with a TBI during 2006 to 2010.

DESIGN

New user design. Generalized estimating equations were used to estimate the relative risks (RRs) of stroke.

MAIN MEASURES

Primary exposure was new antidepressant use following TBI identified through Medicare part D claims. The primary outcome was stroke following TBI. Ischemic and hemorrhagic strokes were secondary outcomes.

RESULTS

A total of 20 859 (32%) beneficiaries used an antidepressant at least once following TBI. Selective serotonin reuptake inhibitors accounted for the majority of antidepressant use. Selective serotonin reuptake inhibitor use was associated with an increased risk of hemorrhagic stroke (RR, 1.26; 95% confidence interval [CI], 1.06-1.50) but not ischemic stroke (RR, 1.04; 95% CI, 0.94-1.15). The selective serotonin reuptake inhibitors escitalopram (RR, 1.33; 95% CI, 1.02-1.74) and sertraline (RR, 1.46; 95% CI, 1.10-1.94) were associated with an increase in the risk of hemorrhagic stroke.

CONCLUSION

Findings from this study will aid prescribers in choosing appropriate antidepressants to treat depression in older adults with TBI.