The Effects of Pretreatment versus De Novo Treatment with Selective Serotonin Reuptake Inhibitors on Short-term Outcome after Acute Ischemic Stroke

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

Abstract

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.

Details

Original languageEnglish
Pages (from-to)1886-1892
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number8
Publication statusPublished - Aug 2015
Peer-reviewedYes

External IDs

Scopus 84938751482
researchoutputwizard legacy.publication#67480
PubMed 26099557

Keywords

Keywords

  • Aged, Aged, 80 and over, Brain Ischemia/complications, Female, Humans, Length of Stay, Male, Middle Aged, Recovery of Function/drug effects, Retrospective Studies, Serotonin Uptake Inhibitors/therapeutic use, Severity of Illness Index, Stroke/drug therapy