Sixteen million people worldwide are affected by stroke annually, and 60 million individuals are stroke survivors. The financial and personal costs of stroke are staggering. Mitigating the sequelae of stroke frequently requires both resources and clinical acumen. One of these sequelae is depression.
The estimated prevalence of depression at any time after stroke is 29%. Predictors of depression include cognitive impairment, stroke severity, prestroke depression, and anxiety. Depression remission is associated with improved functional outcome at 3 months and 6 months, compared with continuing depression. One of the interventions suggested for depression after stroke is the use of selective serotonin reuptake inhibitors.
Investigators conducted a systematic review evaluating the efficacy of SSRIs on clinical outcomes after stroke (Stroke 2013;44:844-50). Fifty-two studies randomizing 4,059 patients to SSRI or a control were included in the final meta-analysis.
SSRIs were significantly associated with less dependency, disability, neurologic impairment, depression, and anxiety. The salutary effects of SSRIs on disability, depression, and neurologic deficits were greater among participants who were depressed when they were randomized.
No increased risk of death, seizures, GI side effects, or bleeding was observed with the use of SSRIs.
Interestingly and importantly, depression was not one of the inclusion criteria for 16 of the included trials. SSRIs may have neurogenic and neuroprotective effects, and animal data suggest that fluoxetine and sertraline facilitate recovery after cortical ischemia.
This evidence poses the reasonable question of whether SSRIs could or should be started in poststroke patients regardless of depressive symptoms.
Dr. Ebbert is professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He reported having no relevant financial conflicts. Reply via e-mail at email@example.com.