No evidence exists to link selective serotonin reuptake inhibitors (SSRIs) to an increased risk of cardiovascular events, including arrhythmia, stroke, or transient ischemic attack, in patients with depression, according to research published in BMJ.

Carol Coupland, MSc, PhD, professor of medical statistics in primary care at the University of Nottingham in the UK, and colleagues conducted a cohort study to assess potential links between SSRI use and myocardial infarction, stroke, or arrhythmia. Participants were between 20 and 64 years of age and were first diagnosed with depression between January 2000 and July 2011.

The researchers analyzed medical records of 238,963 patients for 5 years. Of those patients, 772 had a myocardial infarction, 1106 had a stroke or transient ischemic attack, and 1452 were diagnosed with arrhythmia. In the first year of follow-up, patients treated with SSRIs had a significantly reduced risk of myocardial infarction, and no significant link was found between SSRI use and risk of stroke or arrhythmia; fluoxetine was associated with a significantly reduced risk of myocardial infarction, while lofepramine was associated with a significantly increased risk. After a 5-year follow-up, the researchers found that treatment with tricyclic antidepressants could be linked to an increased risk of arrhythmia during the first 28 days of treatment.

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“This large observational study has found no evidence that selective serotonin reuptake inhibitors are associated with an increased risk of arrhythmia, myocardial infarction, or stroke/transient ischemic attack … but some indication that they are associated with a reduced risk of myocardial infarction and arrhythmia, particularly fluoxetine,” concluded Dr Coupland. “These findings are reassuring in light of recent safety concerns about SSRIs.”


  1. Coupland C, Hill T, Morriss R, et al. Antidepressant use and risk of cardiovascular outcomes in people aged 20 to 64: Cohort study using primary care database. BMJ. 2016;352:i1350; doi: 10.1136/bmj.i1350