Does fluoxetine reduce disability and dependency after stroke?

  • Mead GE & al.
  • Int J Stroke
  • 17 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that fluoxetine does not reduce disability and dependency after stroke but improves depression.

Why this matters

  • Findings do not support the routine prescription of fluoxetine early after stroke in order to reduce dependency and disability.

Study design

  • Meta-analysis included 13 randomised controlled trials (n=4145) after a search across Cochrane, MEDLINE Ovid and other databases.
  • Funding: None.

Key results

  • Fixed effects meta-analysis found no significant difference between fluoxetine and control group in the proportion independent (3 trials, n=3249, 36.6% fluoxetine vs. 36.7% control; relative risk [RR], 1.00; 95% CI, 0.91-1.09; P=.99; I2=78%) and disability (standardised mean difference [SMD], 0.05; 95% CI, −0.02 to 0.12; P=.15; I2=81%) at end of treatment.
  • Fluoxetine vs control group was associated with better neurological (SMD, −0.28; 95% CI, −0.42 to −0.14; P=<.001 i>2=77%) and depression (SMD, −0.16; 95% CI, −0.23 to −0.09; P<.0001 i>2=92%) scores, fewer diagnoses of depression (RR, 0.77; 95% CI, 0.65-0.90; P=.001; I2=53%) but more seizures (RR, 1.49; 95% CI, 1.05-2.11; P=.03).
  • At the end of follow-up, fluoxetine vs control group did not show any effect on disability (2 trials, n=2924; SMD, 0.11; 95% CI, −0.17 to 0.40; P=.45; I2=85%).

Limitations

  • Heterogeneity among studies.
  • Only 4 trials were of high methodological quality.