As if the debilitating effects of depression weren’t enough, we now have further evidence of a link between depression and an increased risk of stroke.

In a study of more than 80,000 older women followed over a six-year period, those with a history of depression or current depression had a 29% greater risk of stroke than those without depression. The risk was even higher, (39%) if antidepressant medications, particularly selective serotonin reuptake inhibitors, were used. Those who were currently experiencing depression had the highest risk of stroke at 41%.

It is important to note that this research only identifies a link, not a causal relationship between depression and stroke. Researchers do not know whether it is the underlying depression or depressive symptoms that increase the risk of stroke, or the medications themselves.

Establishing the link, however, does help doctors treat patients with depression. "Recognizing that depressed individuals may be at a higher risk of stroke could help the physician focus on not only treating the depression, but treating stroke risk factors such as hypertension, diabetes, and elevated cholesterol, as well as addressing lifestyle behaviors such as smoking and exercise," said An Pan, PhD, a research fellow at Harvard School of Public Health in Boston, Massachusetts, and the lead author of the study.

The researchers suggested a few mechanisms that could explain why depression and antidepressant use increases the risk of stroke in women. Depression, they wrote, can cause physiological and hormonal changes in the body or an increased prevalence of poor health behaviors or medical disorders associated with stroke. For example, depressed women were more likely to be single, smokers and less physically active. They were also slightly younger, had a higher body mass index (BMI) and more coexisting conditions such as high blood pressure, heart disease and diabetes.

As for blaming the increased risks on antidepressants, the researchers cited previous studies that found antidepressants can increase weight gain, inflammation, hypertension and abnormal bleeding--all of which can lead to an elevated risk for stroke. However, other studies have found no such association.

They are not recommending that people with depression discontinue treatment or stop taking antidepressant medication. However they say that physicians do need to monitor depressed women closely for stroke risk factors.

Sources:

WebMD

Medscape News