Intracerebral hemorrhage: SSRI use is tied to recurrence risk

  • Kubiszewski P & al.
  • JAMA Neurol
  • 31/08/2020

  • Susan London
  • Clinical Essentials
L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano L'accesso ai contenuti di questo sito è riservato agli operatori del settore sanitario italiano

Takeaway

  • Survivors of intracerebral hemorrhage (ICH) with depression treated with selective serotonin reuptake inhibitors (SSRIs) are more likely to experience recurrence.
  • They are also more likely to experience depression resolution.

Why this matters

  • The findings suggest potential for personalized medicine, given availability of other antidepressant classes.

Key results

  • 21.9% of survivors continued or started SSRIs during follow-up.
  • Survivors exposed vs not exposed to SSRIs had greater likelihood (subHR [SHR]; 95% CI) of:
    • ICH recurrence: 1.31 (1.08-3.59).
    • Remission of post-ICH depression: 1.53 (1.12-2.09).
  • Similar findings in propensity-matched analysis.
  • High-dose vs low-dose SSRIs:
    • Greater ICH recurrence risk (P=.02).
    • Similar likelihood of depression remission (P=.32).
  • Recurrence risk with SSRI exposure differed (P=.008) by baseline risk (SHR; 95% CI):
    • With high recurrence risk: 1.79 (1.22-2.64).
    • Without high recurrence risk: 1.20 (1.01-1.42).
  • Benefit of SSRIs in depression remission did not differ by recurrence risk.

Study design

  • US prospective cohort study of 1279 patients presenting with primary ICH at a tertiary care center, discharged alive.
  • Main outcome: ICH recurrence, depression severity during median 53.2 months of follow-up.
  • High baseline recurrence risk required ≥1 of the following: lobar ICH, history of prior ICH, Black or Hispanic race/ethnicity, APOE gene ε2 or ε4 carrier.
  • Funding: NIH.

Limitations

  • Nonrandomized.
  • Patient adherence unknown.
  • Limited power for certain subgroups.