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Exploring new frontiers in neuropsychopharmacology: SSRIs for stroke

Authors
Journal
Indian Journal of Psychiatry
0019-5545
Publisher
Medknow Publications
Publication Date
Volume
53
Issue
4
Identifiers
DOI: 10.4103/0019-5545.91899
Keywords
  • Editorial
Disciplines
  • Medicine
  • Pharmacology

Abstract

Selective serotonin reuptake inhibitors (SSRIs) are approved treatments for a variety of indications: depression, obsessive–compulsive disorder, generalized anxiety disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder, premenstrual dysphoric disorder, and others.[1] SSRIs are experimental or off-label treatments for a variety of conditions ranging from premature ejaculation[2] to alcoholism.[3] A new frontier now appears to be opening for the use of SSRIs: stroke, a condition which commonly results in physical and cognitive impairments, functional dependence, caregiver burden, and poor quality of life. Importantly, the data for this indication have emerged from clinical trials that were independent of the pharmaceutical industry. What have been the findings? FLUOXETINE AND STROKE A meta-analysis[4] of data from six randomized controlled trials (RCTs) with a pooled sample size of 385 patients suggested that in patients with recent stroke, fluoxetine may reduce the incidence of post-stroke depression [odds ratio (OR) 0.25; 95% confidence interval (CI) 0.11–0.56], promote the recovery of neurological functioning [weighted mean difference (WMD) 4.72; 95% CI 1.13–8.31], and improve independence in activities of daily living (WMD 8.04, 95% CI 2.68–3.40). One of the fluoxetine RCTs[5] provided interesting follow-up data. In the original study, 104 stroke patients were treated for 12 weeks with fluoxetine (up to 40 mg/day), nortriptyline (up to 100 mg/day), or placebo. At a 9-month follow-up,[6] a third of patients were observed to have dropped out of each of the antidepressant arms relative to 14% dropout with placebo. A completer analysis performed on the combined antidepressant versus placebo groups showed that after adjusting for confounding variables such as age, intensity of rehabilitation therapy, baseline stroke severity, and baseline Hamilton Depression Rating Scale (HAM-D) score, patients who had received 3 months of treatment with antidepressant medicati

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