Major depressive disorder and stroke risks: a 9-year follow-up population-based, matched cohort study.
OBJECTIVE
Major depressive disorder (MDD) is characterized by recurrent depressive episodes and one of the treatment choices is antidepressants. Patients with MDD are at greater risk of developing major metabolic diseases that may in turn lead to stroke. Moreover, both depressive symptoms and taking antidepressant medications are associated with higher risk of stroke. However, whether and how clinical depression increases stroke risk remains an unanswered question. Our aim was to provide answers to this question.


METHODS
A matched cohort study of 5015 subjects (1003 MDD patients and 4012 control subjects) was conducted using a nationwide database. Subjects were followed to a maximum of 9 years to determine rates of newly-developed strokes, and controls and MDD groups with different levels of antidepressant refractoriness were compared to determine the temporal relation between stroke and three major metabolic comorbidities (i.e., diabetes mellitus, hypertension and hyperlipidemia). The levels of depressive symptoms and the antidepressant medications before stroke onset were investigated.


RESULTS
Patients with MDD had significantly higher rates of stroke (4.3% vs. 2.8%, p<0.05) during the follow-up. Mediation regression analyses revealed that the occurrence of stroke in the MDD subjects was significantly mediated by the development of major metabolic diseases. Greater severity of depression, but not greater use of antidepressants, preceded the occurrence of stroke.


CONCLUSIONS
A clinical diagnosis of major depression leads to stroke indirectly through more intense depressive symptoms and the development of major comorbidities.
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
Cheng-Ta
CT
Li
Ya-Mei
YM
Bai
Pei-Chi
PC
Tu
Ying-Chiao
YC
Lee
Yu-Lin
YL
Huang
Tzeng-Ji
TJ
Chen
Wen-Han
WH
Chang
Tung-Ping
TP
Su
D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000150:complications* / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents