Risk of Stroke Among Older Medicare Antidepressant Users With Traumatic Brain Injury.

This was an observational study, not a randomized trial. Antidepressant use was not assigned, so differences between users and non-users could explain the associations. The study did not have direct information on TBI severity. It used length of stay and discharge to a skilled nursing facility as proxies. Medicare claims could not capture antidepressant use during the first 100 days of a skilled nursing facility stay after TBI discharge. Beneficiaries using two or more antidepressant classes at the same time were excluded because class effects could not be distinguished. The analysis excluded Medicare Advantage beneficiaries and beneficiaries who did not survive the TBI hospital stay. Some antidepressant classes and individual SSRIs had few users, so the study may have been underpowered to detect some associations. The number analyzed was materially smaller than the number meeting inclusion criteria because prior antidepressant use and other exclusions were required.

The authors declared no conflicts of interest. The publication metadata lists NIH extramural research support, but the article does not state a funder role in design or reporting.

Do not conclude that antidepressants cause stroke or that all antidepressants carry the same risk. This observational Medicare claims study found associations, not proven causation, and the risk differed by antidepressant class and stroke type.