Antidepressants Could Reduce the Effects of Stroke

The Buck Institute for Age Research has been studying the possibility that antidepressants and mood stabilizers, like lithium for example, could have positive effects on stroke victims. The growth of new neurons has been known to diminish the effects of a stroke as well as dramatically improve impaired functions after a stroke, while those types of medications have been found to encourage neurogenesis in rodents.

"What this study shows more convincingly than in the past is that the production of new neurons after stroke is beneficial in rodents," said Buck faculty member and senior author David Greenberg, MD, PhD. "Assuming that neurogenesis is also beneficial in humans, drugs approved by the FDA for other purposes and already shown to promote new neuron growth in rodents might be worth studying as a potential treatment for stroke in humans. For example, antidepressants are often used to treat post-stroke depression, but their potential for improving outcome from stroke itself is less certain."

Researchers compared the size of a stroke and the recovery from stroke in genetically altered mice that either had the ability to grow new neurons or not. It was discovered that mice without the ability to grow new neurons suffered strokes 30% larger; whereas the mice with the ability to grow new neurons showed dramatic improvement of motor functions following a stroke.

Although this new research sounds very exciting, Greenberg cautions that people should not attempt to treat themselves until clear evidence is made official as testing has not been rigorous enough to determine if negative effects exist or whether these positive effects can be seen in humans. Testing these medications that stimulate the growth of neurons could lead to other exciting discoveries for many other age-related disorders, such as Alzheimer’s, Parkinson’s and Huntington’s disease.

“Stroke is the third leading cause of death in the U.S. and is the leading cause of serious long-term disability in this country. Treatments for stroke are limited. Clot busting drugs, which have to be given within hours of the stroke, have been of great benefit to a small number of patients, but stroke is not usually diagnosed in time for them to be used.”

What is a stroke?

A stroke (sometimes called a cerebrovascular accident (CVA)) is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain, caused by a blocked or burst blood vessel. This can be due to ischemia (lack of glucose and oxygen supply) caused by thrombosis or embolism or due to a hemorrhage. As a result, the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech, or inability to see one side of the visual field.

What factors lead to a higher risk of stroke?

• advanced age
  
• hypertension
  
• a previous stroke or transient ischemic attack (TIA)
  
• diabetes
  
• high cholesterol
  
• cigarette smoking
  
• atrial fibrillation

What are the symptoms of stroke?

Symptoms of a stroke that affects the central nervous system include:

• hemiplegia and muscle weakness of the face
  
• numbness
  
• reduction in sensory or vibratory sensation

Generally, the symptoms affect one side of the body and the side affected is typically opposite to the affected brain area.

Symptoms of a stroke that affects the brain stem include:

• altered smell, taste, hearing, or vision
  
• drooping of eyelid and weakness of ocular muscles
  
• decreased reflexes (gag, swallow, pupil reactivity to light)
  
• decreased sensation and muscle weakness in the face
  
• balance problems and nystagmus (involuntary eye movement)
  
• altered breathing and heart rate
  
• weakness in sternocleidomastoid muscle with an inability to turn the head to one side
  
• weakness in tongue (inability to protrude and/or move from side to side)

Symptoms of a stroke that affects the cerebral cortex include:

• aphasia (inability to speak or understand language from involvement of Broca's or Wernicke's area)
  
• apraxia (altered voluntary movements)
  
• visual field defect
  
• memory deficits (with damage to the temporal lobe)
  
• hemineglect (a deficit in attention to and awareness of one side of space is observed when there is damage to the parietal lobe)
  
• disorganized thinking, confusion, hypersexual gestures (with damage to the frontal lobe)
  
• anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)

Symptoms of a stroke that affects the cerebellum include:

• trouble walking
  
• altered movement coordination
  
• vertigo and or disequilibrium

What are the long-term effects?

Disability affects 75% of stroke survivors enough to decrease their employability. Stroke can affect patients physically, mentally, emotionally, or a combination of the three. The results of stroke vary widely depending on size and location of the lesion. Dysfunctions correspond to areas in the brain that have been damaged.

Some of the physical disabilities that can result from stroke include:

• paralysis
  
• numbness
  
• pressure sores
  
• pneumonia
  
• incontinence
  
• apraxia (inability to perform learned movements)
  
• difficulties carrying out daily activities
  
• appetite loss
  
• speech loss
  
• vision loss
  
• pain
  
• coma
  
• death

Some of the mental disabilities that can result from stroke include:

• anxiety
  
• panic attacks
  
• flat affect (failure to express emotions)
  
• mania
  
• apathy
  
• psychosis
  
• depression (characterized by lethargy, irritability, sleep disturbances, lowered self esteem, and withdrawal)
  
• emotional lability (a rapid switch between emotional highs and lows and an inappropriate expression of emotions
  
• speech problems
  
• dementia
  
• attention and memory problems
  
• anosognosia (persistent denial of the existence of a, usually stroke-related, deficit)
  
• hemispatial neglect (inability to attend to anything on the side of space opposite to the damaged hemisphere)
  
• seizures

All resulting affects of stroke are dependent on the severity of brain damage.

Antidepressants as Treatment Immediately Following a Stroke?
Stroke

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Chitosan Could Heal Spinal Cord Injuries

Richard Borgens and his team from the Center for Paralysis Research at the Purdue School of Veterinary Medicine have discovered that chitosan can repair damaged nerve cell membranes. In doing so, the repaired membranes of nerve cells can re-establish the spinal cord's ability to transmit signals to the brain, thus restoring motor abilities.

“Chitosan (pronounced /ˈkaɪtɵsæn/) is a linear polysaccharide composed of randomly distributed β-(1-4)-linked D-glucosamine (deacetylated unit) and N-acetyl-D-glucosamine (acetylated unit).” It is produced commercially by deacetylation of chitin, a derivative of glucose. Chitin can be found in crabs, lobsters, shrimps, insects, squid, octopuses and cell walls of fungi to name a few.

Firstly, the researchers converted chitin to chitosan. They then isolated and compressed a segment of a guinea pig’s spinal cord. Following this, they applied chitosan and a fluorescent dye into the cells through damaged membranes. All of the neurons in the spinal cord tissue remained unstained by the dye under the microscope. While measuring the guinea pig’s brain response, it was noted that signals could not reach the brain because of the damaged spinal cord. “However, 30•min after injecting chitosan into the rodents, the signals miraculously returned to the animals' brains.” Hence, the nerve cells had been successfully repaired.

Borgens and his team also discovered that the levels of LDH leakage from the spinal cord tissue treated with chitosan were lower than those in undamaged spinal cords. “Lactate dehydrogenase catalyzes the interconversion of pyruvate and lactate with concomitant interconversion of NADH and NAD+. It converts pyruvate, the final product of glycolysis to lactate when oxygen is absent or in short supply, and it performs the reverse reaction during the cori cycle in the liver.” Understanding the function of LDH is quite complex, however, in layman’s terms, high levels of LDH are an indication of tissue breakdown or necrosis.

In addition, the researchers uncovered that the sugar repaired any damaged portions of the cell membrane, not only the compressed portion. During their studies, they also found that chitosan could likely be used to repair mitochondrial membranes. “Mitochondria have been implicated in several human diseases, including mitochondrial disorders and cardiac dysfunction, and may play a role in the aging process.” Could further research lead to developing treatments for certain genetic disorder and neurodegenerative diseases?

Chitosan
First Evidence That Chitosan Could Repair Spinal Damage
Lactate dehydrogenase
Mitochondrion

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Neuromarketing: A New Use for fMRI

It’s no surprise that before the human brain and its particularities can be fully understood that corporations will be utilizing major life-enhancing equipment for their own personal gain. Researchers at Duke University and Emory University suggest in their recent analysis that functional MRI can be used as a cost-effective marketing tool.

“Functional Magnetic Resonance Imaging (fMRI) is a type of specialized MRI scan. It measures the hemodynamic response (change in blood flow) related to neural activity in the brain or spinal cord of humans or other animals. It is one of the most recently developed forms of neuroimaging. Since the early 1990s, fMRI has come to dominate the brain mapping field due to its relatively low invasiveness, absence of radiation exposure, and relatively wide availability.”

“So-called "neuromarketing" takes the tools of modern brain science, like the functional MRI, and applies them to the somewhat abstract likes and dislikes of customer decision-making. Though this raises the specter of marketers being able to read people's minds (more than they already do), neuromarketing may prove to be an affordable way for marketers to gather information that was previously unobtainable, or that consumers themselves may not even be fully aware of, says Dan Ariely, the James B. Duke professor of psychology and behavioral economics at Duke.”

In essence, the results from the study of brain scans that boost sales for materialistic items like food and cars is viewed as more valuable than the understanding of mental illness. Evidently, many people view this as a misuse or abuse of valuable medical resources in an attempt at controlling society.

There is no need to describe the obvious ethical issues involved in such techniques that allows marketers to peek into the brains of their consumers, but considerations must be given to consumers’ awareness, consent, and understanding of what could be an invasion of privacy. Moreover, how could toy companies employ such a method?

Despite these concerns, this type of marketing technique could actually do some good by reducing the number of advertisements that use shock tactics and sexual imagery as main selling points for their products. In addition, companies might actually improve their products to meet consumer expectancy.

Obviously the main function of this technique is not to increase scientific knowledge, but a by-product of such marketing tools could lead to a better understanding of how the human brain creates, stores, recalls and relates information. Furthermore, side-effects of such studies could also mean healthier advertising, for instance, reducing negative influences that lead to over-consumption.

If this is where advertising is going, we can only hope that companies will employ professionals to interpret the brain scans as images must be carefully interpreted by individuals with extensive training since misinterpretation could have serious consequences, even for companies promoting their products.

“Neuromarketing may never be cheap enough to replace focus groups and other methods used to assess existing products and advertising, but it could have real promise in gauging the conscious and unconscious reactions of consumers in the design phase of such varied products as "food, entertainment, buildings and political candidates," Ariely says.”

Nonetheless, there could never be enough benefits from this type of marketing to hold more value than the fMRI’s initial intent, in my opinion.

Brain Scans Could Be Marketing Tool of the Future
Functional magnetic resonance imaging
What is ‘neuromarketing’? A discussion and agenda for future research

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Paxil Reduces Benefits of Cancer Treating Drugs

A study in the British Medical Journal found that paroxetine, better known as paxil, decreases the benefits of the cancer treating drug tamoxifen. In addition, they found an increased risk of death in breast cancer patients the longer both drugs were taken concurrently.

Tamoxifen is a popular breast cancer treatment that can be taken for up to five years to prevent a recurrence. Conversely, paroxetine is a selective serotonin reuptake inhibitor (SSRI) antidepressant that is typically used to treat major depression, obsessive-compulsive, panic,social anxiety, and generalized anxiety.

Paroxetine has revealed promise for easing the hot flashes that can occur after cancer treatment. However, this anti-depressant has been known to have side effects such as nausea, somnolence, and sexual problems. This medication is also associated with significant weight gain and adult suicide.

Researchers studied the health records of 2,430 women taking tamoxifen between the years 1993 and 2005. They discovered that roughly 25% or 630 of these women were also taking paroxetine. Of the 1,074 women that died during this period, 374 of them died from breast cancer according to Ontario's cancer registry.

“Tamoxifen is an extremely important drug for breast cancer," said Dr. David Juurlink, a co-author of the study and a scientist at the Institute for Clinical Evaluative Sciences in Toronto. Paroxetine "takes that benefit away by interfering with the body's normal handling of tamoxifen. Specifically, researchers concluded that paroxetine blocks or inhibits an enzyme called cytochrome P450 2D6, which is needed to metabolize tamoxifen into its active form.

Although the evidence suggests that this anti-depressant must be stopped, researchers caution against abruptly ceasing treatment with paroxetine because of withdrawal effects and worsening of depressive symptoms.

Interestingly, the study did not find any increased risk of death among the smaller sample of women taking tamoxifen combined with some other SSRI, such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and venlafaxine (Effexor). However, this smaller sample size may confound the study’s conclusiveness; however it does suggest that attractive alternatives exist.

Furthermore, there are always unanswered questions when it comes to research that focus on health records as several variables are unknown and uncontrolled. That being said, the slightest risk identified should be enough to stop using this medication, especially when there are equally effective substitutes.

Also, in recent news…

“In the first Paxil birth defect trial that resulted in a $2.5 million verdict against GlaxoSmithKline in October 2009, the infant, Lyam Kilker, was born with three heart defects; an atrial septal defect, a ventricular septal defect, and an interrupted aortic arch, after his mother took Paxil while pregnant.”

Antidepressant interferes with breast-cancer drug
Paroxetine
Paxil Birth Defect Trial - Battle of the Experts

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Virtual Reality Therapy Could Benefit Victims of Haiti Earthquake

Cyberpsychology is the study of the human mind and behavior in the context of human-technology interaction. Computer-mediated forms of counseling include e-mails or chats online with a therapist; however cyberpsychology is not limited to the use of internet technology as it also includes cyborgs, artificial intelligence, and virtual reality. This type of therapy can be used to treat various types of mental illness including Post Traumatic Stress Disorder.

PTSD is common in soldiers returning from combat duty, victims of sexual or physical assault and survivors of imprisonment or hostage situations. It is also common among individual that have experienced acts of terrorism, accidents or natural disasters and those diagnosed with a life-threatening illness. Conventional approaches to treat PTSD include antidepressant medication and psychotherapy; however recovery rates are far from acceptable.

“Exposure therapy has been recognized as a highly promising method for treating patients with PTSD. Rather than relying on patients' visualization skills to ‘relive’ the traumatic experience, technological strategies such as virtual reality (VR) provide a controlled environment in which patients can experience a situation or scenario while learning to cope with their emotional responses.”

When natural disasters occur relief efforts typically focus on immediate needs, such food, clothing, shelter, first aid, emotional support and family reunification. Treatment of ongoing mental health should play a vital role in the response. The implementation of this type of tool could have major benefits for mass casualty survivors.

In Haiti, for instance, individuals are experiencing major losses that will affect them for years to come. The loss of loved ones, displacement, medical injuries and material loss are all psychologically devastating. In addition, the victims of this tragedy are likely to be disturbed by memories of the trauma and experience flashbacks of mass graves and friends, neighbours and even family members burned or trapped under collapsed buildings. Furthermore, the destroyed buildings and homes, and the absence of family members will continue to serve as traumatic reminders.

“‘Empty situations’ posed by the sense of an absence of personal location, deprives the victim of a safe ‘holding environment’ so necessary for the recovery process. These secondary adversities caused by displacement function as a barrier to the effort required in ‘processing’ the trauma of personal loss.” Rebuilding the lost structure in their lives is necessary for recovery, however efforts cannot end there. Extended treatment is essential to full or near full recovery, therefore, funding should be applied to ongoing mental health treatment. Virtual reality treatment in safe clinical settings could be part of that effort.

Virtual reality treatment is not a quick fix. It consists of many sessions of gradual exposure and it is most often combined with cognitive behavioral therapy and anxiety management in order to cope with the recreation of the traumatic events. It is important to note that the virtual recreation consists only of certain aspects of the event and not the exact recreation of the event itself.

Evidently, time, money and effort of this type of approach far exceeds the efforts of distributing supplies, however success rates are far more important than quick and easy methods. Moreover, this type of therapy should really be considered for relief personnel as their mental health is also at risk from their experiences. Recovering from the effects of a natural disaster is a lengthy process and the treatment for its effects on mental health is an even lengthier one.

Posttraumatic Stress Disorder: Virtual Reality and Other Technologies Offer Hope
Cyberpsychology
The risk of PTSD following the earthquake in Haiti

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It's Not a Concussion; It's a Brain Injury

The term concussion originates from the Latin concutera, which means to shake violently or the Latin concussus, which refers to the action of striking together. It is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion are often used interchangeably.


The American Academy of Neurology Guidelines ranks the severity of a concussion into 3 grades:

Grade I - Confusion, symptoms last < 15 minutes, no loss of consciousness

Grade II - Symptoms last > 15 minutes, no loss of consciousness

Grade III - Loss of consciousness

Concussion Symptoms:

• Headache
  
• Dizziness
  
• Vomiting
  
• Nausea
  
• Lack of motor coordination
  
• Difficulty balancing
  
• Light sensitivity
  
• Seeing bright lights
  
• Blurred vision
  
• Double vision
  
• Tinnitus
  
• Convulsions
  
• Confusion
  
• Disorientation
  
• Difficulty focusing attention
  
• Loss of consciousness
  
• Post-traumatic amnesia
  
• Confusion
  
• Slurred or incoherent speech
  
• Changes in sleeping patterns
  
• Difficulty with reasoning, concentrating, and performing everyday activities
  
• Crankiness
  
• Loss of interest in favorite activities or items
  
• Tearfulness
  
• Displays of emotion that are inappropriate to the situation

**Common symptoms in children include restlessness, lethargy, and irritability.

Typically symptoms will go away without treatment. Roughly 1% of treated concussions require surgery for a brain injury. Most often plenty of rest is prescribed with a gradual return to normal activities at a pace that does not cause symptoms to worsen.

Medications may be prescribed to treat symptoms associated with the concussion, such as sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches that frequently occur after a concussion, but acetaminophen is preferred to minimize the risk for complications, such as intracranial hemorrhage. Individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they may interfere with the healing process.

Observation to monitor for worsening condition is an important part of treatment. Unconsciousness or altered mental status, convulsions, severe, persistent headache, extremity weakness, vomiting, or new bleeding or deafness in either or both ears suggests that another visit to the doctor is needed. No conclusive evidence suggests that it is necessary to wake a patient up every few hours or not.

Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur. Although the mortality rate is almost zero, repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.

Certain factors may lengthen recovery time, such as longer periods of amnesia or loss of consciousness, substance abuse, clinical depression, poor health or additional injuries sustained and life stress. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained a concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. The prognosis is likely to differ between adults and children; however little research has been done on concussion in the pediatric population. Concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects:

• A decrease in episodic memory (times, places, associated emotions, and other contextual knowledge)
• A decrease in response inhibition
• Delayed P3a/P3b waves recorded via EEG
• An increase in the cortical silence period
• Reduced muscle speed otherwise known as bradykinesia (slow movement)

In recent news, Canadian researchers suggest that the term concussion is scraped from medical terminology as doctors and parents quite often underestimate the severity of these types of injuries.

“Carol DeMatteo, an occupational therapist and associate clinical professor in the School of Rehabilitation Science at McMaster University in Hamilton, Ont., says children diagnosed with concussions are treated differently from kids with other mild brain injuries.” These children are often sent home from the hospital and returned to school much sooner than those treated for mild brain injuries.

The term mild brain injury takes on a more negative connotation that concussion, which tends to suggests that the prognosis is obviously good. Concussion should not be taken as lightly as evidence suggests people who have experience multiple concussions risk neurological damage or even Alzheimer's disease and other dementias.

Natasha Richardson’s tragic death is a perfect example of what might happen when brain injuries are not taken seriously enough. On 16 March 2009, Richardson sustained a head injury when she fell while taking a skiing lesson at the Mont Tremblant Resort in Quebec. The injury was followed by a lucid interval, when she appeared to be fine as she was able to talk and act normally. Paramedics were told they were not needed. She returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. About 7 hours following her fall, she was transferred by ambulance to Hôpital du Sacré-Cœur, in Montreal, in critical condition. The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March. An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an "epidural hematoma due to blunt impact to the head", and her death was ruled an accident. There is a lot of controversy surrounding her death as many believe it could have been prevented with proper medical care.

If the term "mild traumatic brain injury" replaced "concussion", it would help people understand that this type of injury is serious and that it is an injury to the brain, not just the head. It could also save lives and prevent more serious complications later in life.

'Concussion' underplays severity of injury: doctors
Concussion
Natasha Richardson

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Antidepressants May Increase Risk of Stroke or Death in Postmenopausal Women

“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:

• Anxiety
  
• Sleep disturbances
  
• never seem to be enough
  
• dullness
  
• chronic sadness never seeming to end
  
• obsessions
  
• shakiness when feeling most down
  
• mood swings

Medications used to treat depression:

Tricyclic antidepressants

• Amitriptyline
  
• Imipramine
  
• Nortriptyline
  
• Desipramine

Side effects: Fatigue, dry mouth, blurred vision, light-headedness

Selective serotonin-reuptake inhibitors (SSRI)

• Fluoxetine
  
• Fluvoxamine
  
• Sertraline
  
• Paroxetine

Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation

Reversible inhibitors of monoamine oxidase:

• Moclobemide

Side effects: Insomnia, headache, constipation

5-HT2 antagonists:

• Nefazodone

Side effects: Fatigue, light-headedness, nausea, headache

Serotonin-norepinephrine reuptake inhibitors:

• Venlafaxine

Side effects: Nausea, agitation, sweating

MAOIs (monoamine oxidase inhibitors):

• Phenelzine (Nardil)
  
• Tranylcypromine (Parnate)
  
• Isocarboxazid (Marplan)
  
• Selegiline (Emsam)

Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating

“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.

Increased Risk of Death, Stroke in Postmenopausal Women Taking Antidepressants, Study Finds
Monoamine Oxidase Inhibitors
Medications for Treating Depression

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