Abstract
Objective
Post-stroke fluoxetine trials are primarily conducted in high-income countries. We
characterize post-ischemic stroke depression in fluoxetine-treated and -untreated
study participants in urban Tanzania.
Methods
Adults (>18 years old) within 14 days of CT-confirmed acute ischemic stroke onset
were enrolled at Muhimbili National Hospital, Tanzania. The fluoxetine-treated group
took 20mg fluoxetine daily for 90 days in a phase II trial and were compared to fluoxetine-untreated
historical controls. The primary outcome was depression at 90 days, measured by the
Patient Health Questionnaire-9 (PHQ-9). PHQ-9 scores were compared between fluoxetine-treated
and -untreated groups. A score >=9 points was considered to reflect depression. A
multivariable linear regression model assessed associations with post-stroke PHQ-9
scores.
Results
Of the fluoxetine-treated (n=27) and -untreated (n=32) participants, the average age was 56.8 years old (39% women, 100% Black/African).
The average presentation NIHSS score was 12.1 points and modified Rankin Scale (mRS)
score was 3.5. The average mRS score at 90-day follow-up was 2.3. There was no significant
difference between 90-day PHQ-9 scores in the fluoxetine-treated (mean=4.1 points,
standard deviation=3.2; 11% depression) and untreated (mean=4.4, standard deviation=4.8;
19% depression) groups, p=.69. In the multivariable analysis, older age (β=0.08, p=.03) and higher NIHSS score (β=0.15, p=.04), but neither fluoxetine (β=0.57, p=.59) nor sex (β=-0.51, p=.63), were significantly associated with more depressive symptoms.
Conclusions
Our findings parallel results from trials from higher income settings that fluoxetine
does not significantly improve post-ischemic stroke depression, although our sample
size was small. More work is needed to depict the longitudinal nature and treatment
of post-stroke depression in Sub-Saharan Africa.
Key Words
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Article info
Publication history
Published online: November 02, 2021
Accepted:
October 17,
2021
Received in revised form:
October 14,
2021
Received:
September 1,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106181
Copyright
© 2021 Elsevier Inc. All rights reserved.
