title: Impact of prestroke selective serotonin reuptake inhibitor treatment on stroke severity and mortality.
abstract: OBJECTIVE
  Selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of bleeding but also a possible neuroprotective effect in stroke. We aimed to examine the implications of prestroke SSRI use in hemorrhagic and ischemic stroke.
  
  
  METHODS
  We conducted a registry-based propensity score-matched follow-up study among first-ever patients with hemorrhage and ischemic stroke in Denmark (2003-2012). Multiple conditional logistic regression was used to compute adjusted odds ratios of severe stroke and death within 30 days.
  
  
  RESULTS
  Among 1252 hemorrhagic strokes (626 prestroke SSRI users and 626 propensity score-matched nonusers), prestroke SSRI use was associated with an increased risk of the strokes being severe (adjusted propensity score-matched odds ratios, 1.41; confidence interval, 1.08-1.84) and an increased risk of death within 30 days (adjusted propensity score-matched odds ratios, 1.60; confidence interval, 1.17-2.18). Among 8956 patients with ischemic stroke (4478 prestroke SSRI users and 4478 propensity score-matched nonusers), prestroke SSRI use was not associated with the risk of severe stroke or death within 30 days.
  
  
  CONCLUSIONS
  Prestroke SSRI use is associated with increased stroke severity and mortality in patients with hemorrhagic stroke. Although prestroke depression in itself may increase stroke severity and mortality, this was not found in SSRI users with ischemic stroke.
authors.affiliation: From the Department of Neurology, Danish Stroke Centre, (J.K.M., GA.), and Department of Clinical Epidemiology (H.L., S.P.J), Aarhus University Hospital, Aarhus, Denmark. janne.mortensen@ki.au.dk.
authors.forename: Janne Kaergaard
authors.initials: JK
authors.lastname: Mortensen
authors.affiliation: From the Department of Neurology, Danish Stroke Centre, (J.K.M., GA.), and Department of Clinical Epidemiology (H.L., S.P.J), Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Heidi
authors.initials: H
authors.lastname: Larsson
authors.affiliation: From the Department of Neurology, Danish Stroke Centre, (J.K.M., GA.), and Department of Clinical Epidemiology (H.L., S.P.J), Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Søren Paaske
authors.initials: SP
authors.lastname: Johnsen
authors.affiliation: From the Department of Neurology, Danish Stroke Centre, (J.K.M., GA.), and Department of Clinical Epidemiology (H.L., S.P.J), Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Grethe
authors.initials: G
authors.lastname: Andersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D003863:Depression / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D012042:Registries; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D012720:Severity of Illness Index; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: hemorrhage; mortality; stroke