Concerns have long circulated that serotonergic antidepressants may increase bleeding risk and worsen outcomes after traumatic brain injury (TBI). A large, retrospective Finnish cohort study recently examined over 54,000 adults hospitalized with TBI between 2005 and 2018, 14% of whom were taking antidepressants at the time of injury. Researchers investigated whether antidepressant use, antidepressant type, or serotonergic activity influenced 30-day mortality, acute neurosurgical operations (ANOs), or length of hospitalization.

The results were reassuring. After adjusting for age, sex, comorbidities, VKA use, and other covariates, preinjury antidepressant use was not associated with increased 30-day mortality. In fact, antidepressant users were less likely to undergo ANOs, and the length of hospitalization was similar between users and non-users. Neither antidepressant type nor serotonergic potency (weak, moderate, strong) influenced these outcomes. Interaction analyses also showed no evidence that antidepressants worsened the known adverse effects of VKAs on mortality or surgical intervention rates.

These findings offer important clinical reassurance: preinjury antidepressant use, including serotonergic agents, does not appear to worsen early outcomes after TBI. This challenges prior assumptions and suggests that continuing antidepressants in patients at risk for TBI may not necessitate changes based on fear of hemorrhagic or surgical complications.

Reference:

Posti JP et al. Neurology. 2026;106(4):e214602. Abstract