Women with depression may be at higher stroke risk

Women with depression have a higher risk for stroke, according to a new study, adding to the growing amount of information linking depression and stroke. The study also found that women who used certain antidepressants were at higher risk for stroke. The research, by Harvard Public Health and Brigham and Women’s Hospital researchers, is published in Stroke: Journal of the American Heart Association.

Researchers used data from more than 80,000 women enrolled in the Nurses Health Study which began in 1976 and followed registered nurses in 11 states to document their medical histories and health practices. This analysis included women aged 54 to 79, following them from 2000 to 2006. When the study began, none of the women had a history of stroke. Symptoms of depression were measured several times during the study period and researchers noted the use of antidepressant medications.

The researchers found that women with a history of depression had an associated 29% increased risk of stroke. Women who used antidepressants, especially selective serotonin reuptake inhibitors, had an associated 39% increased risk of stroke. Examples of SSRIs include Prozac, Celexa and Zoloft. It’s important to note that the authors clearly state that their findings do not show a causal relationship, and their findings may be a result of other factors that were not measured or explained.

How does this all fit together? Is it the depression or the antidepressants that increases the stroke risk? “I don’t think the medications themselves are the primary cause of the risk,” says  senior author Dr. Kathryn Rexrode. “This study does not suggest that people should stop their medications to reduce the risk of stroke.”

Rexrode, who is an associate professor at both Brigham and Women’s and Harvard Medical School, notes that symptoms of depression can impair people from properly maintaining  health conditions, taking medications or engaging in healthy lifestyle measures including eating properly and exercising. In fact, the study reveals that depressed women were more likely to be less active, have higher weights, and to have medical conditions such as diabetes, high blood pressure and heart disease, which all contribute to increased stroke risk.  The study notes that previous research has shown that antidepressant use is associated with higher rates of inflammation, high blood pressure, and weight gain. Those also are factors that increase stroke risk.

The study does have limitations: The sample was composed primarily of white registered nurses, which may limit the ability to apply the findings to other populations.

The study’s lead author, An Pan of the Harvard School of Public health, says there are actions that can be taken to prevent strokes.  “These risk factors – depression, diabetes, healthy weight and diet, healthy cholesterol, high blood pressure – are all interrelated,” Pan says. “You can’t just treat one risk factor to prevent strokes.  Patients and doctors need to understand the interplay of risk factors for stroke and depression and treat them together.”    Pan revealed that further studies are being planned to examine how depression and stroke are associated.

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