Risk of first onset stroke in SSRI-exposed adult subjects: Survival analysis and examination of age and time effects

Chin Hong Chan, Hsiang Hsiung Huang, Ching Heng Lin, Yi Chun Kuan, El Wui Loh, Tsuo Hung Lan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. Methods: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). Results: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P <.001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. Conclusions: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.

Original languageEnglish
Pages (from-to)e1006-e1012
JournalJournal of Clinical Psychiatry
Volume78
Issue number8
DOIs
Publication statusPublished - Sep 1 2017

Fingerprint

Serotonin Uptake Inhibitors
Survival Analysis
Stroke
International Classification of Diseases
Incidence
Kaplan-Meier Estimate
National Health Programs
Hemostasis
Taiwan
Prescriptions
Young Adult

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Risk of first onset stroke in SSRI-exposed adult subjects : Survival analysis and examination of age and time effects. / Chan, Chin Hong; Huang, Hsiang Hsiung; Lin, Ching Heng; Kuan, Yi Chun; Loh, El Wui; Lan, Tsuo Hung.

In: Journal of Clinical Psychiatry, Vol. 78, No. 8, 01.09.2017, p. e1006-e1012.

Research output: Contribution to journalArticle

Chan, Chin Hong ; Huang, Hsiang Hsiung ; Lin, Ching Heng ; Kuan, Yi Chun ; Loh, El Wui ; Lan, Tsuo Hung. / Risk of first onset stroke in SSRI-exposed adult subjects : Survival analysis and examination of age and time effects. In: Journal of Clinical Psychiatry. 2017 ; Vol. 78, No. 8. pp. e1006-e1012.
@article{53d8efa0543045fba133353650cbc68d,
title = "Risk of first onset stroke in SSRI-exposed adult subjects: Survival analysis and examination of age and time effects",
abstract = "Objective: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. Methods: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). Results: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P <.001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. Conclusions: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.",
author = "Chan, {Chin Hong} and Huang, {Hsiang Hsiung} and Lin, {Ching Heng} and Kuan, {Yi Chun} and Loh, {El Wui} and Lan, {Tsuo Hung}",
year = "2017",
month = "9",
day = "1",
doi = "10.4088/JCP.16m11123",
language = "English",
volume = "78",
pages = "e1006--e1012",
journal = "Journal of Clinical Psychiatry",
issn = "0160-6689",
publisher = "Physicians Postgraduate Press Inc.",
number = "8",

}

TY - JOUR

T1 - Risk of first onset stroke in SSRI-exposed adult subjects

T2 - Survival analysis and examination of age and time effects

AU - Chan, Chin Hong

AU - Huang, Hsiang Hsiung

AU - Lin, Ching Heng

AU - Kuan, Yi Chun

AU - Loh, El Wui

AU - Lan, Tsuo Hung

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Objective: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. Methods: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). Results: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P <.001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. Conclusions: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.

AB - Objective: Exposure to selective serotonin reuptake inhibitors (SSRIs) has been shown to increase the risk of stroke. In this study, we investigated age and time effects on the risk of first onset stroke in SSRI-exposed (SSRIEXP) adult subjects. Methods: We analyzed an 8-year cohort from the National Health Insurance Research Database, Taiwan. Patients were defined as SSRIEXP subjects if they received SSRI prescriptions for at least 2 consecutive months during January 1, 2001, to December 31, 2007. Otherwise, they were categorized as SSRI-nonexposed (SSRINONE) subjects. Stroke diagnosis was made according to ICD-9 codes 430-432 (hemorrhagic stroke) and 433-437 (ischemic stroke). Results: Kaplan-Meier survival analysis showed a greater probability of first onset stroke in SSRIEXP than SSRINONE subjects (P <.001). The higher incidence rates in SSRIEXP subjects persisted to the 3 year time point. Ischemic/hemorrhagic stroke cumulative incidence ratios were also higher during the first 3 years in SSRIEXP subjects. Analysis of adjusted hazard ratios indicated that younger SSRIEXP subjects were more likely to experience stroke, with a slight increase of risk in subjects older than 65 years. Stratified analysis of ischemic stroke and hemorrhagic stroke resulted in a similar hazard ratio trend. Conclusions: Use of SSRIs independently increases the risk of stroke across age strata. The risk is higher in younger adult subjects, and the stroke is more likely to be ischemic than hemorrhagic. The underlying mechanisms of stroke may be related to cerebral microbleeding or an overcorrection of hemostasis function.

UR - http://www.scopus.com/inward/record.url?scp=85032645212&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032645212&partnerID=8YFLogxK

U2 - 10.4088/JCP.16m11123

DO - 10.4088/JCP.16m11123

M3 - Article

C2 - 28994901

AN - SCOPUS:85032645212

VL - 78

SP - e1006-e1012

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

SN - 0160-6689

IS - 8

ER -