Previous studies of Medicare beneficiaries 65 years of age or older have demonstrated that, following traumatic brain injury (TBI), the risk of ischemic and hemorrhagic stroke dramatically increases. As depression is common among elderly patients with TBI, this study assessed whether the risk of stroke is associated with the use of antidepressants.

Using Medicare administrative claims data from January of 2006 through December of 2010, patients who began antidepressant medication use following the TBI were identified. The primary outcome variable was hemorrhagic or ischemic stroke.

During the study period, 64，214 patients were hospitalized for a TBI, all of whom had no previous history of antidepressant use. Of these, 68% had no antidepressant use post-injury and 38% were prescribed antidepressants at least once following the injury. Among the antidepressant users, 4.6% had a hemorrhagic stroke and 11.7% had an ischemic stroke. An adjusted analysis revealed that the new use of serotonin norepinephrine reuptake inhibitors (SNRIs) and phenylpiperazine antidepressants (PPAs) was associated with an increased risk of composite stroke, as well as ischemic stroke. New use of selective serotonin reuptake inhibitors was associated with an increased risk of hemorrhagic stroke.

This study, using a national sample of older Medicare beneficiaries hospitalized for traumatic brain injury, found that the new use of some antidepressants is associated with an increased risk of stroke.