Regular Research ArticlesEffect of Antidepressants on the Course of Disability Following Stroke
Section snippets
Patient Selection
A total of 343 patients between 18 and 85 years, who had a stroke in the previous 6 months, were screened for participation in a study of antidepressant therapy. The protocols were approved by the institutional review boards and written informed consent was obtained from each subject. In addition, we required that the subject's immediate family and treating physician also agreed to the subject's participation. Exclusion criteria included: (1) any other significant medical illness that would
Participants
We compared the background characteristics of the patient treated with fluoxetine (N = 32) and those treated with nortriptyline (N = 22) and found no significant differences except there were significantly fewer women in the fluoxetine compared to the nortriptyline group (Fisher's exact test, p = 0.04). Furthermore, mixed model analysis was performed on the mRS of the nortriptyline and fluoxetine groups controlling for age, total hours of physical rehabilitation, baseline NIHSS score, and
DISCUSSION
This study found that the administration of either nortriptyline and fluoxetine for 3 months significantly reduced disability from stroke over 1 year compared with placebo, even after controlling for age, total hours of physical rehabilitation, baseline severity of stroke (using the NIHSS), and baseline HDRS score. To our knowledge, this is the first time that, independent of depression, antidepressant medication has been shown using double blind methodology to be associated with physical
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2022, Telerehabilitation: Principles and PracticeSerotonin and stroke
2020, Handbook of Behavioral NeuroscienceCitation Excerpt :SSRIs were shown to enhance neurogenesis and neuroplasticity after stroke in animal models (Malberg, Eisch, Nestler, & Duman, 2000; Santarelli et al., 2003; Schmidt & Duman, 2007). Clinical studies have also found that SSRIs enhance motor (Acler, Robol, Fiaschi, & Manganotti, 2009; Chollet et al., 2011; Dam et al., 1996; Pariente et al., 2001; Zittel, Weiller, & Liepert, 2008) and cognitive (Jorge, Acion, Moser, Adams, & Robinson, 2010) recovery and improve the functional outcome of stroke patients (Mikami et al., 2011; Yi, Liu, & Zhai, 2010). The potential benefits of SSRIs in neurologic recovery after stroke are not likely to be mediated by the effect on depression (Mead et al., 2012; Robinson & Jorge, 2016).
The psychopharmacology of brain vascular disease/poststroke depression
2019, Handbook of Clinical NeurologyCitation Excerpt :The potential benefits of antidepressants on other aspects of post stroke recovery suggest that these agents may enhance neuroplasticity. Selective serotonin reuptake inhibitors (SSRIs), in particular, may increase the expression of neurotrophic factors, increase neural and glial precursor proliferation, and increase synaptic complexity in the hippocampus and the prefrontal cortex (Mikami et al., 2011; Harmer et al., 2017). Again, a coherent model linking changes in affective processing and antidepressant response is lacking in patients with depression and stroke.
Effects of Fluoxetine on Poststroke Dysphagia: A Clinical Retrospective Study
2018, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Furthermore, it was reported that early application of fluoxetine promoted a positive neurological prognosis by developing an antioxidant stress effect.16 Treatment with fluoxetine was associated with reduction in disability level as measured by modified Rankin Scale scores at 1 year compared with placebo.17 The beneficial effects of treatment continued for at least 1 year.
Effect of fluoxetine on three-year recurrence in acute ischemic stroke: A randomized controlled clinical study
2018, Clinical Neurology and NeurosurgeryEarly Selective Serotonin Reuptake Inhibitors for Recovery after Stroke: A Meta-Analysis and Trial Sequential Analysis
2018, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Previous clinical studies evaluating the importance of time to SSRIs treatment have provided variable results, ranging from 1 week to 6 months from stroke onset.16,17 Many studies applied relatively late treatment and used a time window up to 3-6 months17,18 from stroke onset, whereas it was reported that early SSRIs treatment (≤30 days from stroke onset) could have a beneficial effect in the recovery of stroke and it was suggested that using SSRIs as early as possible after ischemic stroke could further improve the long-term neurologic functional prognosis.19,20 Evidence from randomized controlled trials (RCTs) reported inconsistent results,21,22 so potential benefits and possible risks associated with the early SSRIs treatment are not fully understood.
The authors would like to thank Stephanie Rosazza, B.A., study coordinator, and Teresa Kopel, M.A., The University of Iowa.
This work is supported in part by NIH grants R01-MH 40355 and R01-MH65134. Dr. Adams received research support from NIH-NINDS (Consultant R01NS19632, and coinvestigator, 5U01NS041895, both 2001–2009), Mayo Foundation for Medical Education/Research (Coinvestigator, 2000–2009), Boehringer–Ingelheim Pharm (Coinvestigator 2003–2009), Merck, Scherling-Plough, and MNT Medical (2003–2009). Dr. Robinson is a consultant for Avanir Pharmaceutical. Dr. Mikami was supported by a grant from Tokai University, Kanagawa, Japan. Drs. Jorge, Davis, Leira and Ms. Jang have no disclosures to report.
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These authors contributed equally to the manuscript.