Abstract
ObjectiveTo assess the effect of antidepressants on functional post-stroke recovery, we conducted a retrospective analysis among acute ischemic stroke patients with a subgroup analysis of severe stroke cases, assessing outcomes through 18 months.MethodsA retrospectively gathered ischemic stroke population was obtained from an institutional database. Grouping was via intention-to-treat with antidepressant use post-stroke or lack thereof. Patients with severe stroke (NIHSS ≥ 21) were further analyzed independently. The primary and secondary outcomes were modified Rankin scale (mRS) and survival over 18 months, respectively. Patient demographics and NIHSS were obtained. Data were analyzed in R using adjusted logarithmic-multivariate models. Adjusted Cox proportional hazards models were used to estimate associations between survival and antidepressants.ResultsEight-hundred six patients (52 severe strokes) received antidepressants post-stroke while 948 (56 severe) did not. The antidepressant group was more female (56% to 43.5%) and had significantly better survival rates (88% vs. 79%, HR 0.62, p < 0.01) but not mRS scores (2.13 vs 2.24, p = 0.262) by the end of the study period. Among severe stroke cases, those receiving antidepressants showed better survival rates (79% vs. 60%, HR 0.36, p=0.026) and most recent mRS score (3.9 vs 5, p < 0.01). The analysis controlling for demographics variables retained significance.ConclusionAntidepressant use post-stroke may improve functional outcomes in patients suffering from severe stroke and may decrease all-cause mortality for strokes of any severity.
Highlights
Ischemic stroke is a significant cause of morbidity and mortality worldwide [1]
The antidepressant group was more female (56% to 43.5%) and had significantly better survival rates (88% vs. 79%, hazard ratios (HR) 0.62, p < 0.01) but not modified Rankin scale (mRS) scores (2.13 vs 2.24, p = 0.262) by the end of the study period
Those receiving antidepressants showed better survival rates (79% vs. 60%, HR 0.36, p=0.026) and most recent mRS score (3.9 vs 5, p < 0.01)
Summary
Ischemic stroke is a significant cause of morbidity and mortality worldwide [1]. Various antidepressant medications, namely, selective serotonin reuptake inhibitors (SSRIs), have demonstrated efficacy at enhancing post-stroke recovery. In 2011, the “FLuoxetine for motor recovery After acute ischaeMic strokE” (FLAME) trial reported enhanced motor recovery post-stroke among patients given 20 mg fluoxetine daily versus placebo over three months [2]. Subsequent meta-analyses of additional placebo-controlled trials post-stroke found similar results to the FLAME trial, correlating fluoxetine treatment with greater independent living functions (mRS of 0-2). These collective results were called into question with the recent “Effects of fluoxetine on functional outcomes after acute stroke” (FOCUS) trial, which did not find significant improvements in functional outcomes among patients given 20 mg fluoxetine daily over six months of follow-up [3]. The trial did, find a decreased incidence of depression among patients receiving fluoxetine and increased incidence of bone fractures [3]
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