SynthesisCNS drugs2018
Risk of Intracranial Hemorrhage Associated with the Use of Antidepressants Inhibiting Serotonin Reuptake: A Systematic Review.
Synthesis in CNS drugs, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Use of serotonin reuptake inhibitor antidepressants and the risk of bleeding complications in patients on anticoagulant or antiplatelet agents: a systematic review and meta-analysis.Annals of medicine · 2022Pooled it
- Plasma Tryptophan Hydroxylase 1 Activity-related Metabolic Markers and Stroke Risk: A Nested Case-control Study.Translational stroke research · 2026Article
- Selective Serotonin Reuptake Inhibitor-Associated Intracranial Hemorrhage: Drug-Specific Risk Patterns and Patient-Level Modifiers.Neurology international · 2025Article
- OnSIDES database: Extracting adverse drug events from drug labels using natural language processing models.Med (New York, N.Y.) · 2025Article
- Clinical Implications of Antidepressants and Associated Risk of Bleeding: A Narrative Review.Current pain and headache reports · 2025Review
- Review
- Comparative Cardiovascular Safety of Duloxetine and Gabapentin in Patients with Hip Osteoarthritis.Journal of pain research · 2025Article
- Concomitant Use of Selective Serotonin Reuptake Inhibitors With Oral Anticoagulants and Risk of Major Bleeding.JAMA network open · 2024Article
- Double cone coil repetitive transcranial magnetic stimulation for severe obsessive-compulsive disorder after reversible cerebral vasoconstriction syndrome with intracerebral hemorrhage: a case report.Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) · 2022Article
- Serotonergic Antidepressants and Risk for Traumatic Intracranial Bleeding.Frontiers in neurology · 2021Article
- Risk of Bleeding Associated With Antidepressants: Impact of Causality Assessment and Competition Bias on Signal Detection.Frontiers in psychiatry · 2021Article
- Article
- Association of prestroke medicine use and health outcomes after ischaemic stroke in Sweden: a registry-based cohort study.BMJ open · 2020Article
- Degree of serotonin reuptake inhibition of antidepressants and ischemic risk: A cohort study.Neurology · 2019Article
- Antidepressants and the Risk of Hemorrhagic Stroke in the Elderly: a Nested Case-Control Study.Drug safety · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundObservational studies have suggested an increased risk of intracranial hemorrhage (ICH) associated with selective serotonin reuptake inhibitors (SSRIs) and other antidepressants primarily inhibiting serotonin reuptake.
objectivesOur aim was to systematically review the available epidemiologic evidence regarding the risk of ICH associated with SSRIs and antidepressants inhibiting serotonin reuptake.
methodsMEDLINE/PubMed and EMBASE were searched for all relevant articles in English, French, or German published before April 2017. Observational studies with SSRIs or any antidepressants classified by strength of serotonin reuptake inhibition as primary exposure, a comparison group, and ICH as outcome were eligible.
resultsAmong twelve identified studies (six nested case-control, three cohort, two case-control, one case-crossover), seven assessed the risk of ICH associated with SSRIs (some also including other antidepressants primarily inhibiting serotonin reuptake), two the risk of ICH associated with inhibitors of serotonin reuptake according to the degree of reuptake inhibition, and three addressed both objectives. Four of ten studies showed an increased risk of ICH associated with SSRIs, with the two largest studies suggesting a moderate effect. Three of five studies showed an increased risk of ICH associated with strong inhibitors of serotonin reuptake. Limitations including residual confounding, inclusion of prevalent users, potentially inappropriate study designs, and lack of power may have influenced these results, especially in studies showing no association or a highly increased risk.
conclusionThis systematic review suggests an increased risk of ICH with antidepressants primarily inhibiting serotonin reuptake, such as SSRIs. An increased risk of ICH with strong inhibitors of serotonin reuptake compared with weak inhibitors is also possible but the available evidence is limited. Antidepressants only moderately or weakly inhibiting serotonin reuptake might be preferred in high-risk patients.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.