Use of Selective Serotonin Reuptake Inhibitors and Risks of Stroke in Patients with Obsessive Compulsive Disorder: A Population-Based Study.
BACKGROUND
Previous research has suggested a link between antidepressants use and the development of cerebrovascular events, but there has never been any study investigating the risk of stroke in obsessive-compulsive disorder (OCD) patients treated with a selective serotonin reuptake inhibitor (SSRI).


METHODS
A retrospective observational cohort study was conducted using data from the National Health Insurance Database of Taiwan between the year of 2001 and 2009. A total of 527 OCD patients with 412 subjects in the SSRI use group and 115 in the non SSRI use group were included. Multivariable Cox proportional-hazards models were used to explore the associations between SSRI use and the occurrence of stroke, controlling for age, gender, concomitant medications, and comorbid medical illnesses.


RESULTS
A total of nineteen OCD patients were diagnosed with new onset of stroke during the follow-up period including six cases in the SSRI group and thirteen in the non SSRI use group. SSRI use was demonstrated to be associated with a decreased risk of stroke (hazard ratio [HR] = 0.30; 95% confidence interval [CI] = 0.10-0.86, P = 0.02). The increase in age-related risk of strokes was 2.55 per decade (HR = 2.55; 95% CI = 1.74-3.75, P<0.001). Alternatively, sex, concomitant use of aspirin and non-steroidal anti-inflammatory drugs, and comorbidities with angina pectoris, diabetes mellitus, hypertension, and hyperlipidemia were not found to be associated with an increased risk for stroke in OCD patients.


CONCLUSIONS
Our study showed that SSRI use was associated with decreased risk of stroke in OCD patients. Further investigation into the possible biological mechanisms underlying the relationship between stroke and SSRI use in OCD patients is warranted.
Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Nantou, Taiwan.
Che-Sheng
http://orcid.org/0000-0002-6911-1839
CS
Chu
Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Psychiatry, School of Medicine, National Yang Ming University, Taipei, Taiwan.|Department of Photonics, National Chiao Tung University, Hsinchu, Taiwan.|College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan.
Po-Han
PH
Chou
Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
Ching-Heng
CH
Lin
Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan.
Chin
C
Cheng
Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.
Chia-Jui
CJ
Tsai
Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Psychiatry, School of Medicine, National Yang Ming University, Taipei, Taiwan.|Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Center for Neuropsychiatric Research, NHRI, Miaoli, Taiwan.
Tsuo-Hung
TH
Lan
Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
Min-Wei
MW
Huang
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America.
Gerald
G
Nestadt
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000188:drug therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced*; D055815:Young Adult
D017367:Selective Serotonin Reuptake Inhibitors