title: Selective serotonin reuptake inhibitor treatment and depression are associated with poststroke mortality.
abstract: BACKGROUND
  Studies generally do not examine patients' prestroke depression diagnoses and treatments.
  
  
  OBJECTIVE
  To examine the association of depression diagnosis and prestroke and/or poststroke selective serotonin reuptake inhibitor (SSRI) treatment with poststroke mortality.
  
  
  METHODS
  We conducted a retrospective study of the medical records of a cohort of veterans with a stroke diagnosis between July 31, 2000, and September 30, 2001. Data regarding demographics, comorbidities, depression diagnosis, and treatment were abstracted from automated databases and electronic medical records for 6 months before and 1 year after the stroke index date. The survival rates of veterans who received an SSRI before and/or after the stroke were estimated using Kaplan-Meier survival analysis. Time-dependent Cox proportional hazards regression model was used to assess the association between risk factors and mortality.
  
  
  RESULTS
  Among 870 veterans, 80 died less than 60 days after their stroke. Among the remaining 790, 12% died within 1 year, 26% died by the end of follow-up (May 1, 2007), and more than 62% were alive at the end of follow-up. Veterans were 3 times as likely to die if they had been treated for depression with an SSRI only before their stroke (hazard ratio [HR], 3.12; 95% CI 1.60 to 6.09). In the time-dependent model, SSRI treatment both before and after the stroke was protective compared with no SSRI treatment during the year following the stroke (HR 0.31; 95% CI 0.11 to 0.86). However, the survival curves crossed over and SSRI treatment before and after stroke conferred greater risk at the end of 7 years (HR 1.36; 95% CI 1.00 to 1.87). Depression diagnosis was associated with greater risk of mortality (HR 1.87; 95% CI 1.24 to 2.82).
  
  
  CONCLUSIONS
  Poststroke SSRI treatment was associated with longer survival even though depression diagnosis was associated with earlier mortality in the unadjusted model. After a stroke, SSRI initiation or resumption of treatment should be considered as part of a medication therapy management service, especially if the patient has a history of depression or was taking an SSRI before the stroke.
authors.affiliation: College of Pharmacy, University of South Florida, Tampa, FL, USA. lried@health.usf.edu
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Ried
authors.forename: Huanguang
authors.initials: H
authors.lastname: Jia
authors.forename: Hua
authors.initials: H
authors.lastname: Feng
authors.forename: Randi
authors.initials: R
authors.lastname: Cameon
authors.forename: Xinping
authors.initials: X
authors.lastname: Wang
authors.forename: Michael
authors.initials: M
authors.lastname: Tueth
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000209:etiology / Q000401:mortality* / Q000523:psychology; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors