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SSRI treatment-associated stroke: causality assessment in two cases
1Department of Psychiatry, University of Calgary, Foothills Medical Centre, Rm. AW258A, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada. rramasub@ucalgary.ca
The Annals of Pharmacotherapy
|May 20, 2004
Summary
Selective serotonin-reuptake inhibitors (SSRIs) were assessed for cerebrovascular adverse drug reactions (CV-ADRs) in two patients. While SSRIs were considered possible contributors to stroke, the specific stroke characteristics were inconsistent with known mechanisms.
Area of Science:
- Pharmacology
- Neurology
- Clinical Toxicology
Background:
- Selective serotonin-reuptake inhibitors (SSRIs) are widely prescribed antidepressants.
- Cerebrovascular adverse drug reactions (CV-ADRs) are a potential concern with SSRI use.
- Causality assessment methods are crucial for evaluating drug-induced events.
Observation:
- Two case studies involving patients experiencing ischemic stroke while on SSRI treatment were analyzed.
- One patient received high-dose paroxetine for three years; the other took a combination of paroxetine, trazodone, and bupropion.
- Clinical and radiological parameters were used alongside a standardized causality assessment scale.
Findings:
- The Naranjo probability scale indicated a possible link between SSRI use and CV-ADRs in both cases.
- However, the specific nature of the strokes and associated findings did not align with established pathophysiological mechanisms of SSRI-induced stroke.
- Major etiological factors for ischemic stroke, such as carotid and cardiothromboembolism, were identified.
Implications:
- Causality assessment aids in the unbiased recognition and reporting of rare adverse events like SSRI-related cerebrovascular accidents.
- Further research is needed to elucidate the precise relationship between SSRIs and stroke risk.
- Clinicians should consider potential CV-ADRs when evaluating patients on SSRIs, particularly those with existing vascular risk factors.