Early Initiation of SSRIs After Stroke May Reduce Neurologic Dysfunction

The use of selective serotonin reuptake inhibitors (SSRIs) ≤30 days from the onset of stroke is associated with a reduction in neurologic dysfunction among patients undergoing poststroke rehabilitation, according to findings from a systematic review published in the Journal of Stroke & Cerebrovascular Diseases.

The Cochrane Library, Embase, and PubMed databases were used to identify 8 randomized controlled trials comprising a total of 1549 patients. All trials evaluated the use of SSRI therapy vs placebo during the initial period following stroke. For this study, the primary outcome was a decrease in the National Institutes of Health Stroke Scale score. Secondary outcomes were improvement in functional independence (modified Rankin Scale score 0-2 at end of follow-up), functional independence, activities of daily living (Barthel index), and depression incidence.

There was a significantly greater decrease in the National Institutes of Health Stroke Scale score among those treated with SSRIs vs those receiving placebo (weighted mean difference 0.82; 95% CI, 0.31-1.33; P =.002). Additionally, early treatment was associated with a significant improvement in both Barthel index (weighted mean difference 5.32; 95% CI, 1.65-8.99; P =.005) and functional independence (risk ratio 2.54; 95% CI, 1.82-3.55; P <.0001). No significant differences were observed between the treatment and placebo groups with regard to change in depression or number of adverse events.

The investigators noted that the limited sample sizes in some of the secondary outcome analyses reduced the ability to reach a definitive conclusion regarding the association between SSRI treatment and changes in depression or number of adverse events. Some of the included trials did not report data on the mean time to treatment, and many of the studies were limited to 90-day follow-up, limiting the ability to determine long-term outcomes of early SSRI treatment in this patient population.

Overall, the findings suggest that more patients may experience quicker recovery from neurologic impairment when provided SSRIs during the acute phase after stroke, making it imperative for clinicians, “to define a precise time window of using SSRIs” to determine which treatment works best for poststroke neurologic recovery.

Reference

Gu SC, Wang CD. Early selective serotonin reuptake inhibitors for recovery after stroke: A meta-analysis and trial sequential analysis [published online December 21, 2017]. J Stroke Cerebrovasc Dis. doi:10.1016/j.jstrokecerebrovasdis.2017.11.031