Background
Selective serotonin reuptake inhibitors (SSRIs) administered in patients following
acute ischemic stroke have shown to improve clinical recovery independently of changes
in depression. Animal studies have demonstrated that sustained SSRI treatment is superior
to short-term SSRI in evoking neurogenesis but how this benefit translates into humans
remains to be answered. We hypothesized that in acute ischemic stroke patients, SSRI
treatment started before the event leads to improved short-term outcomes compared
to de novo SSRI treatment poststroke.
Methods
We performed an exploratory analysis in consecutive acute ischemic stroke patients
and compared patients already receiving fluoxetine, citalopram, or escitalopram with
those who started treatment de novo.
Results
Of 2653 screened patients, 239 were included (age, 69 ± 14 years; 42% men, baseline
median National Institutes of Health Stroke Scale score, 7 [IQR, 10]). Of these patients,
51 started treatment with SSRI before stroke and 188 were prescribed newly SSRIs during
hospitalization. In the adjusted multivariate logistic regression models, SSRI pretreatment
was associated with favorable functional outcome at discharge defined as a modified
Rankin Scale score of 2 or less (odds ratio [OR], 4.00; 95% confidence interval [CI],
1.68-9.57; P < .005), improved early clinical recovery (OR, 2.35; 95% CI, 1.15-4.81; P = .02), and a trend toward prediction of superior motor recovery (OR, 1.82; 95% CI,
.90-3.68; P < .01).
Conclusions
Our data suggest that SSRI pretreatment may improve clinical outcomes in the early
stages of acute ischemic stroke supporting the hypothesis that prolonged SSRI treatment
started prestroke is superior to poststroke SSRI.
Key Words
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Article info
Publication history
Published online: June 20, 2015
Accepted:
April 28,
2015
Received in revised form:
April 13,
2015
Received:
January 30,
2015
Footnotes
This study was conducted at the Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
This study was not supported by any funding.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.04.033
Copyright
© 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.
