ArticleStroke2021
Posttraumatic Stress Disorder, Antidepressant Use, and Hemorrhagic Stroke in Young Men and Women: A 13-Year Cohort Study.
Article in Stroke, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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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.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Associations between posttraumatic stress and stroke: A systematic review and meta-analysis.Journal of traumatic stress · 2023Pooled it
- Hypertension Prevalence, Diagnosis, and Management for Post-9/11 US Veterans.Journal of the American Heart Association · 2026Article
- Insomnia, Sleep Apnea, and Incidence of Hypertension and Cardiovascular Disease Among Men and Women US Veterans.Journal of the American Heart Association · 2025Article
- Blood Pressure Control and Maintenance in U.S. Veterans: Roles of Sex, Race, Ethnicity, and Deprivation.JACC. Advances · 2025Article
- Clinical Management of Sleep Disturbances in Post-9/11 Men and Women Veterans: A 20-year Prospective Cohort Study.Journal of general internal medicine · 2025Article
- Persistent Mental Health-Related Disparities in Stroke Prevention for Atrial Fibrillation in the Era of Direct Oral Anticoagulants.CJC open · 2025Article
- Electronic Health Record Concordance with Survey-Reported Military Sexual Trauma Among Younger Veterans: Associations with Health Care Utilization and Mental Health Diagnoses.Journal of women's health (2002) · 2025Article
- Posttraumatic Stress Disorder Is Associated With Elevated Risk of Incident Stroke and Transient Ischemic Attack in Women Veterans.Journal of the American Heart Association · 2024Article
- Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan.Current atherosclerosis reports · 2024Review
- A marginal structural model to estimate the effect of antidepressant medication treatment on major cardiovascular events among people with post-traumatic stress disorder.Psychological medicine · 2023Article
- Insomnia and Early Incident Atrial Fibrillation: A 16-Year Cohort Study of Younger Men and Women Veterans.Journal of the American Heart Association · 2023Article
- A Mendelian randomization study of genetic liability to post-traumatic stress disorder and risk of ischemic stroke.Translational psychiatry · 2023Article
- Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans.Frontiers in integrative neuroscience · 2023Article
- Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care.Current cardiology reports · 2022Review
- mPR-Specific Actions Influence Maintenance of the Blood-Brain Barrier (BBB).International journal of molecular sciences · 2022Article
- Post-traumatic stress disorder and its association with stroke and stroke risk factors: A literature review.Neurobiology of stress · 2021Review
- Hemorrhagic Stroke Risk in Armed Forces Veterans: The Role of Post-Traumatic Stress Disorder and Its Treatment.Stroke · 2021Article
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 2 countries.
Funding
Abstract
background and purposeAntidepressants are commonly prescribed for posttraumatic stress disorder (PTSD) and may increase the risk of bleeding, including hemorrhagic stroke.
methodsWe prospectively examined independent effects of PTSD, selective serotonin and norepinephrine reuptake inhibitors (SSRI and SNRI) on the risk of incident hemorrhagic stroke in a nationwide sample of 1.1 million young and middle-aged veterans. Time-varying multivariate Cox models were used to examine hemorrhagic stroke risk by PTSD status and use of SSRI or SNRI while adjusting for demographics, lifestyle factors, stroke, and psychiatric comorbidities. Sensitivity analyses controlled for health care utilization.
resultsDuring 13 years of follow-up (2.14 years on average), 507 patients (12% women) suffered a hemorrhagic stroke. The overall incidence rate was 1.70 events per 10 000-person years. In unadjusted models, PTSD was associated with an 82% greater risk of new-onset hemorrhagic stroke (hazard ratio [HR], 1.82 [95% CI, 1.48-2.24]), SSRI use was associated with a >2-fold risk (HR, 2.02 [95% CI, 1.66-2.57]), and SNRI use was associated with a 52% greater risk (HR, 1.52 [95% CI, 1.08-2.16]). In fully adjusted models, effects of PTSD and SNRI were attenuated (adjusted HR, 1.03 [95% CI, 0.81-1.34]; adjusted HR, 1.19 [95% CI, 0.83-1.71]), but SSRI use remained associated with a 45% greater risk of hemorrhagic stroke (adjusted HR, 1.45 [95% CI, 1.13-1.85]). Hypertension, drug abuse, and alcohol abuse were also associated with increased stroke risk. Nonobesity and being non-Hispanic were protective factors. In sensitivity analyses, health care utilization was a small but significant predictor of stroke.
conclusionsIn the largest known investigation of PTSD and antidepressant-associated risk for hemorrhagic stroke in young adults, use of SSRIs, but neither PTSD nor SNRIs were independently associated with incident stroke. SNRIs may be preferable for treating PTSD and comorbid conditions, although pursuing other modifiable risk factors and non-pharmacological treatments for PTSD also remains essential.
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