Effect of Antidepressants on the Course of Disability Following Stroke

Abstract

Objective Stroke often produces marked physical and cognitive impairments leading to functional dependence, caregiver burden, and poor quality of life. We examined the course of disability during a 1-year follow-up period after stroke among patients who were administered antidepressants for 3 months compared to patients given placebo for 3 months. Methods A total of 83 patients entered a double-blind randomized study of the efficacy of antidepressants to treat depressive disorders and reduce disability after stroke. Patients were assigned to either fluoxetine (N = 32), nortriptyline (N = 22) or placebo (N = 29). Psychiatric assessment included administration of the Present State Examination modified to identify DSM-IV symptoms of depression. The severity of depression was measured using the 17-item Hamilton Depression Rating Scale. The modified Rankin Scale was used to evaluate the disability of patients at initial evaluation and at quarterly follow-up visits for 1 year. Impairment in activities of daily living was assessed by Functional Independence Measure at the same time. Results During the 1-year follow-up period, and after adjusting for critical confounders including age, intensity of rehabilitation therapy, baseline stroke severity, and baseline Hamilton Depression Rating Scale, patients who received fluoxetine or nortriptyline had significantly greater improvement in modified Rankin Scale scores compared to patients who received placebo (t [156] = − 3.17, p = 0.002). Conclusions Patients treated with antidepressants had better recovery from disability by 1-year post stroke (i.e., 9 months after antidepressants were stopped) than patients who did not receive antidepressant therapy. This effect was independent of depression suggesting that antidepressants may facilitate the neural mechanisms of recovery in patients with stroke.

Effects of serotonin reuptake inhibitors in neuronal plasticity after stroke

“…No total foram selecionados 16 artigos, dentre eles, dois (2) estudos transversais (ET), um (1) coorte, quatro (4) estudos randomizados e controlados (RCT), quatro (4) estudos de revisões (RS) e cinco (5) cartas ao editor (CE). Dos artigos selecionados, somente 11 foram analisados, exluindo-se as cartas ao editor [5][6][7][8][9][10][11][12][13][14] (Quadro 1).…”

“…Os resultados mostraram progressão média da Fugl-Meyer Motor Scale após 90 dias de intervenção: 17,1 versus 52,7, sendo significativamente maior que no grupo placebo 4 . Além da fluoxetina, outro RCT observou o efeito da nortriptilina (25-100mg), administrada por 6 semanas e da fluoxetina (10-40mg), administrada por 3 semanas, e observaram que em ambos os grupos a pontuação da escala de rankin modificada foi similar em comparação com os pacientes que receberam placebo 9 .…”

“…8 Pariente et al 5 Loubinoux et al 6 Choi-Kwon et al 10 Barker-Collo et al 11 Berends et al 7 Berends et al 12 Mead et al 13 Chollet et al 4 Mikami et al 9 Mead et al…”

Post-stroke depression

“…Mikami és munkacsoportja [68] a stroke kimenetelét vizsgálta a módosított Rankin-skálával (mRS) placebó-val, nortriptilinnel és fl uoxetinnel kezelt betegeknél. Egy évvel a kezelés megkezdése után szignifi kánsan jobb mRS-értékek mutatkoztak az antidepresszívummal kezelt betegcsoportokban, függetlenül attól, hogy a betegnél a vizsgálat valamelyik szakaszában depresszió alakulte ki vagy sem.…”

Improving Recovery After Stroke

“…39 -41 Recent data show that antidepressant medications also might be useful in fostering recovery in nondepressed patients. 41,42 Because antidepressant medications are widely and safely used, they would be strong candidates to be used as adjunctive agents in the subacute phase of stroke. The selective serotonin reuptake inhibitors are of particular interest because of their safety profile in patients with heart disease and stroke.…”