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SSRI
treatment-associated stroke: causality assessment in two
cases.
Ramasubbu R.
Department of
Psychiatry, University of Calgary, Foothills Medical Centre, Rm. AW258A,
1403 29th St NW, Calgary, Alberta T2N 2T9, Canada.
rramasub@ucalgary.ca
OBJECTIVE: To assess the probability of
cerebrovascular adverse drug reactions (CV-ADRs) due to treatment with
selective serotonin-reuptake inhibitors (SSRIs) using 2 causality
methods. case summaries: Two patients with the possibility of
SSRI-related stroke were referred for causality assessment. Causality
assessment was performed using an adverse drug reaction probability
scale, as well as clinical and radiologic parameters. A 31-year-old
white man, who had been receiving paroxetine 200 mg/day over a period of
3 years, developed ischemic stroke involving left middle cerebral
artery. The second patient was a 46-year-old white woman with a history
of recurrent depression who developed delirium and ischemic stroke while
she was taking a combination of paroxetine 50 mg/day, trazodone 200
mg/day, and bupropion 150 mg/day. DISCUSSION: Carotid and
cardiothromboembolism were found to be the major etiological factors for
ischemic stroke. Accounting for the temporal relation, prior reports of
SSRI treatment-associated CV-ADRs, and the pharmacologic action of
serotonin on coagulation and the vascular system, the possible
contribution of SSRIs to stroke in these patients was considered. An
objective causality assessment using the Naranjo probability scale
revealed that a CV-ADR was possible. However, the nature of the stroke,
plus clinical and radiologic findings, were inconsistent with known
pathophysiologic mechanisms linking SSRIs and stroke in these patients.
CONCLUSIONS: Causality assessment may improve unbiased recognition,
management, and voluntary reporting of infrequent adverse effects such
as SSRI treatment-related cerebrovascular accident.
PMID:
15150381 [PubMed - in process]
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