- 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.
- 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.
- 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.
- Patient adherence unknown.
- Limited power for certain subgroups.