Abstract
Background Several studies investigated the use of selective serotonin reuptake inhibitors (SSRI) after ischemic stroke to improve motor recovery. However, little is known about the effects of preexisting psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke functional disability. Objective We sought to determine the prevalence of PPMU and whether PPMU relates to the long-term clinical outcome in a cohort of patients presenting with acute ischemic strokes. Methods We retrospectively analyzed 323 consecutive patients who presented with an acute ischemic stroke in a single institution between January 2015 and December 2017. Baseline characteristics, functional disability as measured by the modified Rankin Scale (mRS), and major adverse cardiovascular complications (MACE) within 365 days were recorded. The comparison groups included a control group of ischemic stroke patients who were not on psychotropic medications before and after the index ischemic stroke and a second group of poststroke psychotropic medication use (PoMU), which consisted of patients started on psychotropic medication during the index admission. Results The prevalence of PPMU in the studied cohort was 21.4% (69/323). There was a greater proportion of females in the PPMU than in the comparison groups (P < 0.001), while vascular risk factors were similar in all groups, except for an increased presence of posterior circulation infarcts in the PPMU (37.4% vs. 18.8%, P < 0.001). Among the patients with available 1-year follow-up data (n = 246), we noted significantly greater improvement in stroke deficits, measured by National Institute of Health Stroke Scale (NIHSS) between PPMU and PoMU vs. control (3 (0-7) versus 1 (0-4), P = 0.041). The 1-year mRS was worse in PPMU and PoMU compared to the control group (2 (IQ 1-3) vs. 2 (IQ 0-3) vs. 1 (IQ 0-2), respectively, P = 0.013), but delta mRS reflecting the degree of mRS improvement showed no significant difference between any PMU and control patients (P = 0.76). There was no statistically significant difference in MACE. Conclusion PPMU in ischemic stroke is common; it can be beneficial in ischemic stroke in the long-term clinical outcome and is not associated with increased risks of MACE.
Highlights
Stroke is the third leading cause of worldwide disability [1] and a leading cause of serious long-term disability in the US, reducing mobility in more than half of its survivors aged 65 and older [2]
69 (21.4%) patients were on psychotropic medication use (PPMU), 28 (8.7%) patients were on psychotropic medication use (PoMU), and 226 (69.9%) patients served controls
We found that the clinical deficit severity as measured by the National Institute of Health Stroke Scale (NIHSS) at one year was significantly worse in PoMU compared to control and PPMU patients, respectively
Summary
Stroke is the third leading cause of worldwide disability [1] and a leading cause of serious long-term disability in the US, reducing mobility in more than half of its survivors aged 65 and older [2]. Preexisting psychotropic medication use (PPMU) prior to the onset of an ischemic stroke on long-term stroke outcome is unknown. There has been only one cohort study that investigated the association between SSRI use prior to an ischemic stroke and subsequent outcome within 30 days [16]. Several studies investigated the use of selective serotonin reuptake inhibitors (SSRI) after ischemic stroke to improve motor recovery. Little is known about the effects of preexisting psychotropic medication use (PPMU), such as antidepressants, on a long-term ischemic stroke functional disability. We sought to determine the prevalence of PPMU and whether PPMU relates to the long-term clinical outcome in a cohort of patients presenting with acute ischemic strokes. PPMU in ischemic stroke is common; it can be beneficial in ischemic stroke in the long-term clinical outcome and is not associated with increased risks of MACE
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