Psychotropic use and risk of stroke among patients with bipolar disorders: 10-year nationwide population based study
Journal
Journal of Affective Disorders
Journal Volume
226
Pages
77-84
Date Issued
2018
Author(s)
Abstract
Objectives To investigate the association between psychotropic agents (including antipsychotics, antidepressants and mood stabilizers) and risk of stroke among patients with bipolar disorders. Methods We conducted a disease risk score-matched nested case-control study and identified patients with bipolar disorders (ICD-9 codes: 296.0x, 296.1x, 296.4x, 296.5x, 296.6x, 296.7x, 296.80, 296.81 or 296.89) from the National Health Insurance Research Database in Taiwan. Among them, we identified 1232 cases (981 were ischemic stroke and 251 were hemorrhagic stroke) and 5314 disease risk score-matched controls. Conditional logistic regression model equations were applied to determine the effect of psychotropic agents on stroke risk among patients with bipolar disorders. Results The results indicated that overall use of psychotropic agents was associated with an increased risk of stroke (adjusted odds ratio [AOR] = 1.82; 95% confidence interval [CI]: 1.56–2.13). When classifying psychotropic agents into antipsychotics, antidepressants and mood stabilizers, respectively, a significant positive association was found for users of antipsychotics (AOR = 1.98; 95% CI = 1.53–2.56), antidepressants (AOR = 1.44; 95% CI = 1.16–1.79), and mood stabilizers (AOR = 1.89; 95% CI = 1.22–2.93). Combined use of psychotropic agents was associated with higher risk of stroke than monotherapy (AOR = 2.62; 95% CI = 1.98–3.45). Discussions The results support our hypothesis that psychotropic use is associated with increased risk of stroke among patients with bipolar disorders. The stroke risks are higher among patients with polypharmacy than those with monotherapy. These findings warrant further investigation to confirm and replicate the findings using different methodologies and populations, and to mitigate residual confounding. ? 2017 Elsevier B.V.
Subjects
Antidepressants; Antipsychotics; Bipolar disorders; Mood stabilizers; Stroke
SDGs
Other Subjects
amisulpride; amitriptyline; antidepressant agent; aripiprazole; chlorpromazine; chlorprothixene; citalopram; clomipramine; clotiapine; dosulepin; doxepin; escitalopram; fluoxetine; flupentixol; fluvoxamine; haloperidol; imipramine; melitracen; mood stabilizer; neuroleptic agent; olanzapine; paliperidone; paroxetine; prochlorperazine; quetiapine; risperidone; sertraline; sulpiride; thioridazine; zotepine; anticonvulsive agent; antidepressant agent; neuroleptic agent; psychotropic agent; tranquilizer; adult; Article; bipolar disorder; brain hemorrhage; brain ischemia; case control study; cerebrovascular accident; comparative study; controlled study; drug use; female; human; major clinical study; male; middle aged; monotherapy; priority journal; sensitivity analysis; aged; bipolar disorder; cerebrovascular accident; chemically induced; factual database; International Classification of Diseases; methodology; odds ratio; statistical model; Taiwan; Adult; Aged; Anticonvulsants; Antidepressive Agents; Antimanic Agents; Antipsychotic Agents; Bipolar Disorder; Brain Ischemia; Case-Control Studies; Databases, Factual; Female; Humans; International Classification of Diseases; Logistic Models; Male; Middle Aged; Odds Ratio; Psychotropic Drugs; Research Design; Stroke; Taiwan
Type
journal article