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(Stroke. 2002;33:1448.)
© 2002 American Heart Association, Inc.

Editorials

Use of Selective Serotonin Reuptake Inhibitors and the Risk of Stroke: Is There Reason for Concern?

Dimitrije Jakovljevi, MD Jaakko Tuomilehto, MD, MPolSc, PhD

From the KTL-National Public Health Institute, Department of Epidemiology and Health Promotion (D.J, J.T), and the University of Helsinki, Department of Public Health (J.T), Helsinki, Finland.

Correspondence to Dimitrije Jakovljeviæ, MD, KTL-National Public Health Institute, Department of Epidemiology and Health Promotion, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail dimitrije.jakovljevic@ktl.fi

Key Words: antidepressive agents • serotonin • stroke • stroke, hemorrhagic

Depression is a highly prevalent chronic illness¹ that is more frequent in women than in men.² It is also one of the most widespread causes of years lost due to disability,³ which by some projections will take the leading place among the most important diseases in developing countries and third place in developed countries by the year 2020.⁴ Depression has a strong impact on society due to the severe burden of disease, and therefore it is one of the foremost public health issues facing physicians today.⁵ The rapid growth of the elderly population worldwide further intensifies the problem of depression, because its prevalence among people older than 65 years is estimated to be at least 15%.^6,7 Depressive symptoms frequently occur among patients with atherosclerosis and coronary artery disease.^8–10 While it is well known that depression is one of many sequelae of stroke,^11,12 some recent studies have shown that depressive symptoms and psychological distress might also predict ischemic stroke.^13,14

In an attempt to explain the relationship between cardiovascular disease and depression, some studies have suggested pathophysiological mechanisms including altered autonomic nervous system activity, increased tendency of blood coagulation, and elevated low-grade inflammation.^15,16 In addition to these pathophysiological pathways, increased platelet aggregability in depression may play a role in the process, leading to poststroke depression.¹⁷ According to Cohen et al,¹⁸ depression may double the risk of heart attack in hypertensive patients, particularly among women. Despite the large number of studies aiming to clarify various aspects and triggering events of this disorder, many . . . [Full Text of this Article]