TO THE EDITOR: Serotonergic antidepressants are one of the most commonly prescribed psychiatric medications. The literature suggests that serotonergic antidepressants may be protective against ischemic cerebrovascular accidents (CVAs),1, 2 which has been thought to be due to effects on platelet activation and aggregation.3 However, the clinical relevance of the association between serotonergic antidepressants and CVAs has been challenged in recent reports.1, 4 We aimed to assess this association in a sample of older adults with severe mental illness.
We performed a retrospective cohort study on 217 older adults (age ≥ 65 years) discharged from a psychiatric inpatient admission between 2003 and 2008 at the Jewish General Hospital, Montreal, Canada. Patients were subcategorized into the following groups: (1) exposed (n = 106) and (2) unexposed (n = 111) to serotonergic antidepressants. Patients taking any selective serotonin reuptake inhibitors or serotonin norepinephrine reuptake inhibitors or both were considered serotonergic antidepressant-exposed. The main outcome measure was incident ischemic CVA over 5-year follow-up. We also examined rates of any abnormal bleeding as a safety measure …