Degree of serotonin reuptake inhibition of antidepressants and ischemic risk: a cohort study

Objective: To assess whether the use of antidepressants with strong inhibition of serotonin reuptake is associated with a decreased incidence of ischemic stroke and myocardial infarction (MI).

Methods: We conducted a cohort study using the United Kingdom Clinical Practice Research Datalink and considering new users of selective serotonin reuptake inhibitors (SSRIs) or third-generation antidepressants aged ≥18 years between 1995 and 2014. Using a nested case-control approach, each case of a first ischemic stroke or MI identified during follow-up was matched with up to 30 controls on age, sex, calendar time, and duration of follow-up. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CIs) of each outcome associated with current use of strong compared with weak inhibitors of serotonin reuptake using conditional logistic regression.

Results: The cohort included 938,388 incident users of SSRIs (n = 868,755) or third-generation antidepressants (n = 69,633). Mean age...