Abstract WP402: Risks and Benefits of Selective Serotonin Reuptake Inhibitor Use Among Survivors of Intracerebral Hemorrhage

Abstract

Introduction: Selective Serotonin Reuptake Inhibitors (SSRIs) are widely used to treat post-stroke depression, but they increase Intracerebral Hemorrhage (ICH) incidence in the general population. ICH survivors must therefore balance ICH recurrence risk with depression treatment benefits when considering SSRI use. We sought to determine risks and benefits of SSRI use among survivors of primary ICH. Hypothesis: SSRI exposure following ICH is associated with increased recurrent ICH risk and decreased depression severity. Methods: We analyzed data from the MGH-ICH study. We collected baseline patient information (demographics, race/ethnicity, medical history), ICH characteristics (location, size, associated functional impairment) and determined genetic (APOE e2/e4) and MRI markers of underlying small vessel disease. Participants were followed by phone and EMR review to determine: 1) recurrent ICH events; 2) onset and severity of depression (using the GDS-4 scale). We conducted univariable and multivariable analyses for ICH recurrence risk and depression severity as a function of SSRI exposure. We conducted a subset analysis for patients with one or more of the following characteristics associated high ICH recurrence risk: 1) probable or possible CAA diagnosis (Boston criteria); 2) presence of APOE e2/e4 gene variants; 3) prior history of ICH/TIA/ischemic stroke; 4) black or Hispanic race/ethnicity. Results: We enrolled and followed longitudinally 1010 ICH survivors. SSRI exposure was associated with both ICH recurrence (HR 1.22, 95% CI 1.06 - 1.40) and improvement of depressive symptoms (OR 0.73 for increase in GDS-4 score quartiles, 95% CI 0.59 - 0.90). Among individuals at high ICH recurrence risk SSRI use was associated with higher risk for ICH recurrence compared to all other ICH survivors (interaction p = 0.012). SSRI effect on depressive symptoms did not differ between high ICH recurrence risk individuals and all other participants. Conclusions: SSRI exposure is associated with both improvement in depressive symptoms after ICH and with increased hemorrhage recurrence risk. Clinical history, neuroimaging data and genetic biomarkers may represent viable tools to identify ICH survivors more likely to safely tolerate SSRI use.