title: Risk of Stroke Among Older Medicare Antidepressant Users With Traumatic Brain Injury.
abstract: To estimate the risk of stroke associated with new antidepressant use among older adults with traumatic brain injury (TBI).
  
  
  
  A total of 64 214 Medicare beneficiaries aged 65 years or older meeting inclusion criteria and hospitalized with a TBI during 2006 to 2010.
  
  
  
  New user design. Generalized estimating equations were used to estimate the relative risks (RRs) of stroke.
  
  
  
  Primary exposure was new antidepressant use following TBI identified through Medicare part D claims. The primary outcome was stroke following TBI. Ischemic and hemorrhagic strokes were secondary outcomes.
  
  
  
  A total of 20 859 (32%) beneficiaries used an antidepressant at least once following TBI. Selective serotonin reuptake inhibitors accounted for the majority of antidepressant use. Selective serotonin reuptake inhibitor use was associated with an increased risk of hemorrhagic stroke (RR, 1.26; 95% confidence interval [CI], 1.06-1.50) but not ischemic stroke (RR, 1.04; 95% CI, 0.94-1.15). The selective serotonin reuptake inhibitors escitalopram (RR, 1.33; 95% CI, 1.02-1.74) and sertraline (RR, 1.46; 95% CI, 1.10-1.94) were associated with an increase in the risk of hemorrhagic stroke.
  
  
  
  Findings from this study will aid prescribers in choosing appropriate antidepressants to treat depression in older adults with TBI.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore (Mr Khokhar and Dr Simoni-Wastila); and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore (Dr Albrecht).
authors.forename: Bilal
authors.initials: B
authors.lastname: Khokhar
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Albrecht
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D016022:Case-Control Studies; D016001:Confidence Intervals; D003863:Depression / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology* / Q000503:physiopathology; D015996:Survival Rate; D014481:United States
chemical_list: D000928:Antidepressive Agents