Selective Serotonin Reuptake Inhibitors for Stroke Recovery

Abstract

Each year, about 16 million people in the world experience a first-ever stroke. Of these, about 5.7 million die and another 5 million remain disabled.1 Although there are effective treatments that restore brain perfusion and minimize complications and recurrent stroke, there is no treatment proven to facilitate neurological recovery after stroke. A recent small trial demonstrated that the selective serotonin reuptake inhibitor (SSRI) fluoxetine, commonly used to treat depression, improved motor recovery and reduced dependency after stroke when given to people without depression.2 Experimental studies reporting neurogenic and neuroprotective effects of SSRIs3,4 provide a plausible mechanism of action. Our objective was to systematically review and perform a meta-analysis of all (published and unpublished) randomized controlled trials of SSRI compared with control, given within the first year of stroke, to determine the effect on dependency, disability, and other important clinical outcomes. ### Searches and Study Selection Extensive literature searches were performed between August 2011 and March 2012 (see Data in online-only Data Supplement); this included searching the gray literature. Two review authors scrutinized the searches of Cochrane Stroke Group, CENTRAL, CCDAN and the trials registers, and applied inclusion criteria. One review author scrutinized the other searches and applied inclusion criteria. We included all randomized controlled trials in patients with a clinical diagnosis of stroke, in which SSRIs were given within the first year of stroke, for any clinical indication. The control arm included usual care or a placebo. Any drug classified as an SSRI (for example fluvoxamine, fluoxetine, sertraline, citalopram, escitalopram, and paroxetine) given at any dose, by any mode of delivery, was included. Drugs with mixed effects were not included. Two review authors independently extracted data, except for papers in Chinese, for which 1 review author extracted data. ### Outcomes The primary outcomes were dependence and disability. The secondary outcomes were neurological …