A new preliminary study, scheduled for presentation at the upcoming American Stroke Association’s International Stroke Conference 2024, reveals that antidepressant medications are generally safe for most ischemic stroke survivors. This includes the critical early recovery phase post-stroke when patients are at an increased risk of major bleeding events.

The study attempts to address concerns that medical professionals may have about prescribing antidepressants soon after a stroke, fearing these medications may increase bleeding risks. Consequently, some stroke survivors may not receive the depression treatment they need, potentially compromising their quality of life and recovery.

Depression after a stroke, experienced by an estimated 20 to 40 percent of stroke survivors, could negatively impact recovery in various ways, including less participation in rehabilitation and poor adherence to medication. Depression has also been shown to independently raise the risk of another stroke or cardiovascular event.

Antidepressants such as SSRIs or SNRIs may not be prescribed soon enough after a stroke, when the risk of depression and anxiety is especially high, because of the believed increase in the risk of a hemorrhagic stroke or serious bleeds.

The researchers inspected the frequency of serious bleeds in over 600,000 ischemic stroke survivors who took different types of SSRI and SNRI antidepressants, among other variants, drawing from medical records from 70 large healthcare centers in the U.S.

The investigation revealed simply put, SSRIs and SNRIs are generally safe to start during the important early stages of stroke recovery. Stroke survivors using these medications didn't possess a higher risk of serious bleeds compared to those not taking an antidepressant. This was true even for patients also on anticoagulation therapy.

However, the risk of serious bleeding increased slightly when SSRIs or SNRIs were taken in combination with aspirin and blood thinners, but significant bleeding events remained rare. Antidepressants from other classes, like mirtazapine, bupropion, and older tricyclic antidepressants, increased serious bleeding risks by 15 percent compared to SSRIs or SNRIs.

These findings encourage clinicians to consider SSRIs and SNRIs as safe antidepressant options for most stroke survivors early after their stroke occurrence to manage post-stroke depression and anxiety. These solid results underscore the importance of prompt depression treatment to assist stroke survivors in their recovery process.