Antidepressant Use After Aneurysmal Subarachnoid Hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH), almost always from a rupture of a saccular intracranial aneurysm (sIA), affects the working-age population. The reported incidence is 4 to 7 per 100 000, but it is 3× higher in Finland. Subsequent mortality is high: 22% at 1 month and 27% at 12 months in our series of 1657 patients, mainly because of poor condition and signs of brain injury on admission. Along with various degrees of acute or delayed brain injury, long-term survivors are often affected by neurological and cognitive disorders. Depression after sIA-SAH has been reported in ≤33% of survivors. Depression was associated with a poor quality of life, and it may slow down rehabilitation and complicate reintegration to previous living conditions and occupation. Previous studies are mostly cross-sectional, diagnostic criteria of depression vary, and the use of antidepressant medication and the impact of comorbid epilepsy have not been comprehensively studied. Recommendations for first-line treatment, especially in moderate and severe depression, include antidepressants. Depression is the most frequent indication for antidepressant use in Finland. The Kuopio Intracranial Aneurysm Database (http:// www.kuopioneurosurgery.fi) includes all cases of ruptured intracranial sIAs admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population. Medical data from the Finnish national registries, including hospital diagnoses and the use of prescribed medicines, have been fused to the database. In this study, we analyzed the use of antidepressant medication of the 12-month survivors after sIA-SAH and their Background and Purpose—To elucidate the predictors of antidepressant use after subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) in a population-based cohort with matched controls. Methods—The Kuopio sIA database includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland, with 3 matched controls for each patient. The use of all prescribed medicines has been fused from the Finnish national registry of prescribed medicines. In the present study, 2 or more purchases of antidepressant medication indicated antidepressant use. The risk factors of the antidepressant use were analyzed in 940 patients alive 12 months after sIA-SAH, and the classification tree analysis was used to create a predicting model for antidepressant use after sIA-SAH. Results—The 940 12-month survivors of sIA-SAH had significantly more antidepressant use (odds ratio, 2.6; 95% confidence interval, 2.2–3.1) than their 2676 matched controls (29% versus 14%). Classification tree analysis, based on independent risk factors, was used for the best prediction model of antidepressant use after sIA-SAH. Modified Rankin Scale until 12 months was the most potent predictor, followed by condition (Hunt and Hess Scale) and age on admission for sIA-SAH. Conclusions—The sIA-SAH survivors use significantly more often antidepressants, indicative of depression, than their matched population controls. Even with a seemingly good recovery (modified Rankin Scale score, 0) at 12 months after sIA-SAH, there is a significant risk of depression requiring antidepressant medication. (Stroke. 2016;47:2242-2248. DOI: 10.1161/STROKEAHA.116.014327.)