Venlafaxine better than Fluoxetine for Early Post Stroke Depression

A recent study published in Neurology India has shown a higher effectiveness for venlafaxine in improving depressive symptoms and concomitant anxiety.

Post stroke depression (PSD) is an under diagnosed morbidity of stroke and can negatively affect the prognosis of the patient. Depression following stroke can hamper the progress of the patient both physically as well as socially and hence should be given proper attention and management. The evidences for prevention and management of PSD are still limited.

Post-stroke depression (PSD) has long been recognized as a neuropsychiatric complication of strok but often remains unrecognised and/or undertreated owing to its challenging diagnosis. According to an estimate about one third of post stroke patients suffer from substantial depressive symptoms.

Antidepressant therapy is very well tried and established in the treatment of post stroke depression (PSD). The commonly used treatment strategies for PSD are SSRIs and SNRIs. Even though there are comparative studies of these agents, their comparison literature is sparse in PSD. SSRIs are currently the preferred agents because of their prompt action and better side effect profiles and the treatment is usually continued for at least 4–6 months before it is tapered and stopped.

Neuroscientists from Kochi studied the compared the safety and efficacy profiles of Serotonin (SSRI) and Venlafaxine (SNRI) in post stroke depression patients. It was a non-experimental, comparative, prospective follow-up study During the study period, 326 stroke patients were admitted in the department, of which 73 were diagnosed with depression - including 45 males and 28 females. The prevalence of PSD was found to be 22.4% in stroke patients.

Out of the 73 patients, 60 were included in the study.

Of the 60 patients included in the study 30 each were treated with fluoxetine and venlafaxine (41.09%). The common adverse effects found in both the group were hyponatremia, headache, insomnia, and anxiety . Graphical comparison of adverse drug reactions (ADRs) of both the drugs showed a higher incidence of ADRs in the Fluoxetine arm (61.54%) than Venlafaxine arm (38.46%).

Out of the 30 patients in the Venlafaxine group, 16 patients were found to have very severe depression, 12 had severe depression and 2 had moderate depression during the initiation of therapy. After 8 weeks, 7 patients had normal scores, 17 had mild depression, and 6 had moderate depression. In the fluoxetine treated group, the baseline score was found to be very severe for 6 patients, severe for 19 patients and moderate for 5 patients. At the end of the study, 3 patients had normal score, 16 had mild score, and 11 had moderate score.

On statistical analysis, authors found that venlafaxine was found to be more effective than fluoxetine in the treatment of post-stroke depression.

The authors found that venlafaxine is better than fluoxetine regarding safety and efficacy. There was no significant difference seen in the adverse drug reactions caused by venlafaxine and fluoxetine. However, the incidence of hyponatremia was higher in the fluoxetine group which was consistent with other studies.

Reference: Fluoxetine or Venlafaxine for Early Post Stroke Depression

Vivek K Nambiar, J Parvathy, Tania M Philip, K Abhijith, S Sreeni, Naveen K Panicker, Amrutha V Ajai, TS Dhanya Neurology India DOI: 10.4103/0028-3886.364069