Antidepressants Containing “SSRI,” Users Have any Higher Risk of Hemorrhagic Strokes



  • A group of researchers reported on Wednesday. The antidepressants are known as selective serotonin reuptake inhibitors (SSRIs) and include widely used drugs like fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil.) This also has been linked to a risk of stomach bleeding. But studies have come to conflicting findings on whether SSRI users have any higher risk of hemorrhagic strokes, which happen when there is bleeding in or around the brain.


 The study that appeared in the journal of Neurology researchers pooled the findings from sixteen past studies involving more 500,000. Over all about antidepressant users
Were about 40 to 50 percent more likely to suffer bleeding in or around the brain?
Based on these figures, he said, there would be one brain hemorrhage for every 10,000 people using an SSRI over one year.


Daniel Hackam: researcher professor of medicine at Western University in London, Ontario, Canada. Said while those numbers might sound big, the risks to any one person would be “extremely low.”


SSRIs seem to make it harder for blood cells called platelets to clump together and form clots. And there can be a big drop in a person’s platelet function in the first weeks after starting an SSRI, Hackam noted.


Based on these figures, he said, there would be one brain hemorrhage for every 10000 people using an SSRI over one year.


“We can’t infer cause and effect from this,” Hackam said. “I think that overall, these medications are quite safe.”


He added that people who are already at increased risk of a brain hemorrhage might need to be careful. That includes people who’ve had a brain bleed in the past, or are on medications that reduce blood clotting such as warfarin (Coumadin), or a combination of aspirin and clopidogrel (Plavix).


These findings emphasize the importance of appropriate patient selection and avoidance of inappropriate prescribing, which assumes particular importance in patients at increased risk of (brain hemorrhage).”


Still, he stressed that people on the antidepressants should not be alarmed.


Here is a list of some antidepressants containing SSRIs


Selective serotonin reuptake inhibitors, also known as SSRIs, are used to treat depression. According to the Mayo Clinic, medical researchers aren’t certain how they actually work. Neurotransmitters, particularly serotonin, may affect behavior and mood. SSRIs affect the neurotransmitters by preventing them from being reabsorbed into brain nerve cells.


Fluoxetine is marketed under the names Prozac, Prozac Weekly, Rapiflux, Selfemra and Sarafem. Prozac was the first SSRI introduced in the United States; it was introduced in 1987. Fluoxetine can treat depression, obsessive-compulsive disorder, panic disorder, premenstrual dysphoric disorder and bulimia nervosa. Side effects may include restlessness, chills, anxiety, confusion, diarrhea, increased hunger and thirst, mood changes and lethargy. Withdrawal symptoms may include insomnia, paranoia, dizziness, euphoria and sweating.


Citalopram is sold as Celexa. It may not begin to seriously alter mood and depression for up to four weeks. Side effects may include loss of emotion, memory loss, changes in menstruation, difficulty breathing, decreased sex drive, anxiety, lethargy, nose bleeds, weight gain, seizures, shakiness, stomach pain, mental confusion, constipation, drooling, swelling, fatigue and hallucinations, among others. Taking too much of the medication can cause convulsions, dizziness, pain, vomiting, weakness and coma.


Lexapro (escitalopram) may be prescribed for generalized anxiety disorder as well as depression. It is available as a tablet or liquid. Common side effects, which may vanish a short time after starting the medication, include diarrhea, lowered libido, insomnia, stomach pain, gas and heartburn. Side effects that are rare but require medical attention include weakness, nausea, cramps, less urination, confusion, convulsions and coma.


Paxil, Pexeva and Paxil CR are the brand names of paroxetine. Along with depression, paroxetine also may be prescribed for OCD, social phobia and post-traumatic stress disorder. It is available in pill or liquid form. Side effects may include agitation, sensitivity to light, speaking difficulties, blurry vision and depression.


Sertraline is the generic name of Zoloft. It may be prescribed for anxiety disorders as well as depression. It is available as a liquid, capsule or tablet. Paroxetine may cause such side effects as a rash, restlessness, skin spotting, tenderness in the breast, aggression, chills, speaking difficulties, dry skin and blindness.


Olanzapine and Fluoxetine
Symbyax is a combination of olanzapine and fluoxetine. The medication is an SSRI antidepressant and an antipsychotic. It is of particular use in treating bipolar disorder depression. It is available as a capsule. Side effects may include delusions, changes of voice, trembling, weight gain, fever, dementia and blurry vision. Such side effects as difficulty speaking, speech pattern changes and seizures require emergency medical attention.


Journal of Neurology


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