SSRIs effective for Improving Post-stroke Recovery, finds meta-analysis

Jordan: A meta-analysis study reported that selective serotonin reuptake inhibitors (SSRIs) are safe and effective in post-stroke recovery. The study was published in the Journal of the American Heart Association.

Globally, Stroke is the second leading cause of mortality affecting 13.7 million people each year. Despite the availability of safe and effective reperfusion therapies, stroke causes long-term functional disability in up to 75% of survivors. These data suggest an urgent need for novel treatment strategies to improve post-stroke recovery, particularly in view of the ongoing demographic change toward population ageing, in developed and developing countries around the globe. In recent years, great progress has been made in the treatment of acute stroke but post-stroke disability is still an unsolved problem. Selective serotonin reuptake inhibitors (SSRIs) are a class of drugs that are typically used as antidepressants in the treatment of the major depressive disorder, anxiety disorders, and other psychological conditions.

Several clinical studies have shown SSRIs might improve clinical recovery from the stroke but they were limited by small sample sizes and heterogeneous designs. Heba M, University of Jordan, Jordan and colleagues decided to conduct a systematic review and meta‐analysis to investigate the efficacy and safety of SSRIs in post-stroke recovery.

Investigators searched PubMed, Cochrane, Scopus, and Google Scholar databases for the studies that were placebo‐controlled trials in design and reported SSRIs' effects on post-stroke depression, anxiety, disability, dependence, motor abilities, and cognitive functions. The quality of the included studies was assessed using the revised Cochrane risk‐of‐bias tool for randomized trials. The search yielded 44 articles consisting of 16 164 patients and about half of them were treated with SSRIs.

The review results showed that,

• SSRIs had a significant effect on preventing and treating depression and also on improving anxiety, motor function, cognitive function, and dependence in patients after stroke.

• There was no significant improvement in disability after treatment with SSRs

• Treatment with SSRIs increased the risk of seizures (RR-1.44), but there was no difference in the incidence of gastrointestinal symptoms or bleeding between SSRIs and a placebo.

• The subanalysis results showed that citalopram was significantly associated with improving the post-stroke recovery of depression, cognitive function, and motor function but fluoxetine was only effective in treating post-stroke depression.

The authors concluded that SSRIs are effective in preventing and treating depression, and improving anxiety, motor function, cognitive function, and dependence in patients after stroke. The positive findings on SSRIs were mainly driven by citalopram and not fluoxetine, suggesting that citalopram but not fluoxetine improved the recovery outcomes of patients after stroke.

The authors emphasized the need for well‐conducted placebo‐controlled trials to investigate the safety and efficacy of citalopram among patients after stroke.

Heba M. Kalbouneh, Ahmad A. Toubasi, Farah H. Albustanji, Yazan Y. Obaid and Layla M. Al‐Harasis

Originally published22 Jun 2022 https://doi.org/10.1161/JAHA.122.025868Journal of the American Heart Association. 2022; 0:e025868