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Efficacy of Fluoxetine for Post-Ischemic Stroke Depression in Tanzania

      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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      References

        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders.
        DSM-5, United States2013
        • Towfighi A
        • Ovbiagele B
        • El Husseini N
        • Hackett ML
        • Jorge RE
        • Kissela BM
        • Mitchell PH
        • Skolarus LE
        • Whooley MA
        • Williams LS.
        Poststroke depression: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2017; 48: e30-e43
        • Ojagbemi A
        • Akpa O
        • Elugbadebo F
        • Owolabi M
        • Ovbiagele B.
        Depression after Stroke in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.
        Behav Neurol. 2017; 4160259
        • Hankey GJ
        • Hackett ML
        • Almeida OP
        • Flicker L
        • Mead GE
        • Dennis MS
        • Etherton-Beer C
        • Ford AH
        • Billot L
        • Jan S
        • Lung T
        Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial.
        The Lancet Neurol. 2020; 19: 651-660
        • Almeida OP
        • Hankey GJ
        • Ford A
        • et al.
        Depression Outcomes Among Patients Treated With Fluoxetine for Stroke Recovery: The AFFINITY Randomized Clinical Trial.
        JAMA Neurol. 2021; 78 (PMID: 34338714. Published online August): 1072-1079https://doi.org/10.1001/jamaneurol.2021.2418
        • Vogel AC
        • Okeng'o K
        • Chiwanga F
        • Ismail SS
        • Buma D
        • Pothier L
        • Mateen FJ.
        MAMBO: Measuring ambulation, motor, and behavioral outcomes with post-stroke fluoxetine in Tanzania: Protocol of a phase II clinical trial.
        J Neurol Sci. 2020; 408116563
        • Saadi A
        • Okeng'o K
        • Biseko MR
        • Shayo AF
        • Mmbando TN
        • Grundy SJ
        • Xu A
        • Parker RA
        • Wibecan L
        • Iyer G
        • Onesmo PM
        • Kapina BN
        • Regenhardt RW
        • Mateen FJ.
        Post-stroke social networks, depressive symptoms, and disability in Tanzania: A prospective study.
        Int J Stroke. 2018; 13: 840-848
        • World Bank
        GNI per capita, Atlas method (current US).
        2021 (Available from) (Accessed 23 Aug)
        • Muhimbili National Hospital Profile
        Muhimbili National Hospital.
        2021 (Accessed 23 Aug)
        • Walker R
        • Whiting D
        • Unwin N
        • Mugusi F
        • Swai M
        • Aris E
        • Jusabani A
        • Kabadi G
        • Gray WK
        • Lewanga M
        • Alberti G.
        Stroke incidence in rural and urban Tanzania: a prospective, community-based study.
        The Lancet Neurol. 2010; 9: 786-792
        • Pharmaccess Group
        A Closer Look at the Healthcare System in Tanzania.
        2021 (Available from:) (Accessed 27 Aug)
        • Kroenke K
        • Spitzer RL
        • Williams JB.
        The PHQ-9: validity of a brief depression severity measure.
        J Gen Intern Med. 2001; 16: 606-613
        • Omoro SA
        • Fann JR
        • Weymuller EA
        • Macharia IM
        • Yueh B.
        Swahili translation and validation of the Patient Health Questionnaire-9 depression scale in the Kenyan head and neck cancer patient population.
        Int J Psychiat Med. 2006; 36: 367-381
        • Chollet F
        • Tardy J
        • Albucher JF
        • Thalamas C
        • Berard E
        • Lamy C
        • Bejot Y
        • Deltour S
        • Jaillard A
        • Niclot P
        • Guillon B.
        Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial.
        The Lancet Neurol. 2011; 10: 123-130
        • Lundström E
        • Isaksson E
        • Näsman P
        • Wester P
        • Mårtensson B
        • Norrving B
        • Wallén H
        • Borg J
        • Dennis M
        • Mead G
        • Hankey GJ.
        Safety and efficacy of fluoxetine on functional recovery after acute stroke (EFFECTS): a randomised, double-blind, placebo-controlled trial.
        The Lancet Neurol. 2020; 19: 661-669
        • Dennis M
        • Mead G
        • Forbes J
        • Graham C
        • Hackett M
        • Hankey GJ
        • House A
        • Lewis S
        • Lundström E
        • Sandercock P
        • Innes K.
        Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial.
        Lancet North Am Ed. 2019; 393: 265-274
        • Regenhardt RW
        • Biseko MR
        • Shayo AF
        • Mmbando TN
        • Grundy SJ
        • Xu AI
        • Saadi A
        • Wibecan L
        • Kharal GA
        • Parker R
        • Klein JP.
        Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania.
        Int J Qual Health Care. 2019; 31: 385-392