Fluoxetine ineffective in preventing post-stroke apathy and depression

UK: Jonathan Tay and colleagues undertook an investigation to ascertain the impact of fluoxetine on post-stroke apathy and found that treatment with fluoxetine is ineffective, says an article published in SAGE International Journal of Stroke.

Apathy is a frequent and incapacitating stroke symptom that lacks effective therapies. Although selective serotonin reuptake inhibitors are frequently used to treat depressive symptoms following a stroke, it is uncertain if they also lessen apathetic symptoms. Fluoxetine dramatically enhanced mood scales in patients with ischemic or hemorrhagic stroke in the subacute phase, according to results from EFFECTS (Efficacy of Fluoxetine - a Randomized Controlled Experiment in Stroke), one of the largest serotoninergic drug trials in post-stroke rehabilitation. 

For this study, EFFECTS recruited patients aged >=18 between 2 and 15 days following the beginning of the stroke. For six months, participants were given either a placebo or oral fluoxetine 20 mg once a day, at random. At baseline and six months, the Montgomery-Sberg Depression Rating Scale (MADRS) was given. This scale's individual items were separated into those that indicated signs of despair and indifference. Between the fluoxetine and placebo groups, symptoms were compared.

The key findings of this study were:

1. Complete MADRS data for 1369 of the 1500 registered subjects was available.

2. 681 patients received fluoxetine, while 688 received a placebo in the modified intention-to-treat population.

3. A confirmation factor analysis demonstrated the dissociability of apathic, depressive, and anhedonic symptoms.

4. Both the fluoxetine and placebo groups had an increase in apathy levels. Conversely, fluoxetine was linked to a decrease in depressed symptoms.

In conclusion, this study is unable to demonstrate any fluoxetine-related effects on post-stroke apathy or anhedonia. The regular use of fluoxetine in post-stroke anhedonia or apathy should be avoided by clinicians. Additional research should determine whether these illnesses are similarly unresponsive to other serotonergic medications.

Reference: 

Tay, J., martensson, B., Markus, H. S., & Lundström, E. (2022). Does fluoxetine reduce apathetic and depressive symptoms after stroke? An analysis of the EFFECTS trial dataset. In International Journal of Stroke (p. 174749302211247). SAGE Publications. https://doi.org/10.1177/17474930221124760