Inhibition of serotonin reuptake by antidepressants and cerebral microbleeds in the general population

Nikkie Aarts; Saloua Akoudad; Raymond Noordam; Albert Hofman; M Arfan Ikram; Bruno H Stricker; Loes E Visser; Meike W Vernooij

doi:10.1161/STROKEAHA.114.004990

Inhibition of serotonin reuptake by antidepressants and cerebral microbleeds in the general population

Stroke. 2014 Jul;45(7):1951-7. doi: 10.1161/STROKEAHA.114.004990. Epub 2014 May 29.

Authors

Nikkie Aarts¹, Saloua Akoudad¹, Raymond Noordam¹, Albert Hofman¹, M Arfan Ikram¹, Bruno H Stricker², Loes E Visser¹, Meike W Vernooij¹

Affiliations

¹ From the Department of Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Department of Epidemiology (N.A., S.A., R.N., A.H., M.A.I., B.H.S., L.E.V., M.W.V.), Department of Radiology (S.A., M.A.I., M.W.V.), and Department of Neurology (S.A., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.); and Apotheek Haagse Ziekenhuizen - HAGA, The Hague, the Netherlands (L.E.V.).
² From the Department of Internal Medicine (N.A., R.N., B.H.S., L.E.V.), Department of Epidemiology (N.A., S.A., R.N., A.H., M.A.I., B.H.S., L.E.V., M.W.V.), Department of Radiology (S.A., M.A.I., M.W.V.), and Department of Neurology (S.A., M.A.I.), Erasmus Medical Center, Rotterdam, the Netherlands; Inspectorate of Health Care, The Hague, the Netherlands (B.H.S.); and Apotheek Haagse Ziekenhuizen - HAGA, The Hague, the Netherlands (L.E.V.). b.stricker@erasmusmc.nl.

PMID: 24876079
DOI: 10.1161/STROKEAHA.114.004990

Abstract

Background and purpose: Serotonin reuptake inhibiting antidepressants decrease platelet aggregation. This may cause an increased risk of intracerebral hemorrhage. However, the risk of subclinical microbleeds, which are highly prevalent in middle-aged and elderly people, is unknown. We studied whether serotonin reuptake inhibiting antidepressants increase the frequency of cerebral microbleeds and secondarily whether they lower the presence of ischemic vascular damage.

Methods: Within the population-based Rotterdam Study, information on antidepressant use was obtained from continuously monitored pharmacy records. Brain MRI was available in 4945 participants (55% women, mean age 64 years) between 2005 and 2011. We categorized antidepressants based on affinity for the serotonin transporter: high, intermediate, or low. Microbleeds (presence and location) and ischemic lesions (lacunes, white matter lesions) were rated on MRI. Logistic and linear regression, adjusted for age, sex, depressive symptoms, and cardiovascular risk were used to study the association of antidepressants with microbleeds and ischemic vascular lesions.

Results: Antidepressant use with strong serotonin reuptake inhibition was not associated with microbleed presence (odds ratio compared with nonuse, 1.03; confidence interval, 0.75-1.39) irrespective of microbleed location in the brain. Exclusion of antithrombotic users or persons with cortical infarcts did not change our results. Furthermore, serotonin reuptake inhibition was not related to ischemic vascular brain damage.

Conclusions: In the general population, use of serotonin reuptake inhibiting antidepressants is not related to presence of cerebral microbleeds. This strengthens the idea that the platelet inhibitor effects of antidepressant drugs with affinity for serotonin are minimal and further supports the safety of selective serotonin reuptake inhibitors for nongastrointestinal bleedings.

Keywords: antidepressive agents; cerebral small vessel diseases; serotonin.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Brain / blood supply
Brain / pathology*
Brain Ischemia / chemically induced
Brain Ischemia / diagnosis
Cerebral Hemorrhage / chemically induced*
Cerebral Hemorrhage / diagnosis
Depression / drug therapy
Drug Prescriptions / statistics & numerical data
Female
Humans
Magnetic Resonance Imaging
Male
Microvessels / pathology
Middle Aged
Netherlands
Prospective Studies
Risk
Selective Serotonin Reuptake Inhibitors / adverse effects*
Selective Serotonin Reuptake Inhibitors / classification
Selective Serotonin Reuptake Inhibitors / pharmacology

Substances

Serotonin Uptake Inhibitors