Depression is already a known risk factor for cardiovascular disease but it seems that taking antidepressants may significantly increase the risk of stroke for women who are postmenopausal.  The study is based on data from the well respected Women’s Health Initiative which was responsible for proving that hormone replacement therapy significantly increased the risk of heart attack, stroke, cancer and death in postmenopausal women.

This latest study took place over six years and involved over 136,000 women between the ages of 50 and 79. The study found that those taking antidepressants were 45 percent more likely to suffer from a stroke during that period than women not taking the drugs, and 32 percent more likely to die from any cause.  The risk of stroke for a postmenopausal woman taking an antidepressant was roughly one in 200 in each given year and the increased stroke risk from antidepressants remained the same regardless of which drug class women were taking – whether selective serotonin reuptake inhibitors (SSRIs) or tricyclics.  However SSRIs appeared to pose a higher risk for a hemorrhagic stroke caused by brain bleeding.

The Stroke Association are currently funding further studies to look into the links between depression and the risk of stroke.  If you want to reduce your own risk then simple steps to take are lifestyle changes such as reducing your blood pressure, giving up smoking, reducing alcohol intake, improving your diet and getting plenty of exercise.

Cancer, wherever it occurs, brings a whole maelstrom of emotions and feelings along with the physical effects and depression is certainly one of them. If a woman with breast cancer takes Paroxetine, the generic name of an SSRI drug now commonly prescribed for depression, there is a serious risk to consider.

Paroxetine may be given under the trade names of Seroxat or Paxil and if taken at the same time as Tamoxifen has an increased risk of death according to a study published on the British Medical Journal website. Why the increased risk? Because paroxetine itself does not cause or influences the course of breast cancer but it impairs the effectiveness of Tamoxifen.

Whatever the advisability or not of taking Tamoxifen, the reality is that in order to work, it must be converted into an active metabolite (endoxifen) by the liver and antidepressants can interfere with this process. Because it is common for women with breast cancer to be on antidepressants for long periods of time, and although many antidepressants have little or no impact on tamoxifen’s metabolism, paroxetine is a potent inhibitor of the metabolic step that converts tamoxifen to endoxifen.

This latest research was carried out by Dr Catherine Kelly and colleagues at the Institute for Clinical Evaluative Sciences (ICES) in Toronto and they concluded that Paroxetine, but not other SSRIs, in combination with Tamoxifen, was associated with an increased long-term risk of breast cancer death. The researchers estimate that treatment with paroxetine for 41 percent of the total time on Tamoxifen will result in one additional breast cancer death at five years for every 20 women so treated. One of the study’s authors, David Juurlink a scientist at ICES, went further and stated that “these results highlight a drug interaction that is extremely common, widely underappreciated and potentially life-threatening, yet uniformly avoidable.”

This means that the choice of antidepressant can significantly influence survival in women taking Tamoxifen for breast cancer, so needs to be thoroughly discussed with your doctor or cancer team. Any women currently taking this potentially lethal duo also needs to discuss withdrawal of the antidepressant as it should not be abruptly withdrawn to minimise side effects.