This Article Full Text Full Text (PDF) All Versions of this Article: 39/3/857    most recent STROKEAHA.107.498097v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Steffens, D. C. Articles by Burke, G. L. PubMed PubMed Citation Articles by Steffens, D. C. Articles by Burke, G. L. Pubmed/NCBI databases Medline Plus Health Information Antidepressants MRI Scans Related Collections Behavioral Changes and Stroke

(Stroke. 2008;39:857.)
© 2008 American Heart Association, Inc.

Original Contributions

Antidepressant Treatment and Worsening White Matter on Serial Cranial Magnetic Resonance Imaging in the Elderly

The Cardiovascular Health Study

David C. Steffens, MD, MHS; Hyoju Chung, PhD; K. Ranga R. Krishnan, MD; W.T. Longstreth, Jr, MD, MPH; Michelle Carlson, PhD Gregory L. Burke, MD, MSc

From the Departments of Psychiatry and Behavioral Sciences (D.C.S., K.R.R.K.), Duke University Medical Center, Durham, NC; the Departments of Biostatistics (H.C.), Neurology (W.T.L.), and Epidemiology (W.T.L.), University of Washington, Seattle; the School of Public Health (M.C.), Johns Hopkins University, Baltimore, MD; and the Department of Public Health Sciences (G.L.B.), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to David Steffens, Departments of Psychiatry and Behavioral Sciences, Duke University Medical Center, Box 3903, Durham, NC 27710. E-mail steff001{at}mc.duke.edu

Background and Purpose— In some studies, late life depression is associated with white matter lesions on MRI. The effect of different classes of antidepressants on progression of white matter lesions is unknown. Selective serotonergic reuptake inhibitors (SSRIs) may decrease platelet aggregation. We hypothesized that Cardiovascular Health Study participants taking SSRIs would less often have worsening white matter on serial MRI than participants not on antidepressants.

Methods— Among 1826 participants who were not using an antidepressant at initial MRI scan, we examined the association of worsening in white matter grade from initial to follow-up MRI scans, 5 years apart on average, and antidepressant use between the scans. Logistic regression models were used, controlling for a variety of potential confounding variables.

Results— Use of any antidepressant during the period of study was associated with worsening white matter. In a multivariable model, risk was slightly increased, not reduced, with use of serotonergic agents (OR 1.36, 95% CI 0.87 to 2.12) and was significantly increased with the use of tricyclic antidepressants (OR 1.77, 95% CI 1.07 to 2.94).

Conclusions— The association between worsening white matter and use of tricyclic antidepressants was an unexpected finding that may relate to indications for use other than depression or to side effects such as hypotension. Protection against worsening was not seen with use of serotonergic agents.

Key Words: antidepressant • depression • neuroimaging • serotonin • white matter