SSRIs for stroke recovery: new Cochrane review

  • Legg LA & al.
  • Cochrane Database Syst Rev
  • 26 Nov 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Cochrane review found that selective serotonin reuptake inhibitors (SSRIs) do not improve recovery after stroke.
  • SSRIs reduced the risk for future depression in all patients with stroke but increased the risk for gastrointestinal side effects.

Why this matters

  • Findings provide no indication for the routine prescription of SSRIs to promote stroke recovery.
  • Review provides information about the risk associated with SSRIs in stroke which will help clinicians to weigh risks and benefits of SSRIs in patients at higher risk for depression.

Study design

  • Review identified 63 randomised controlled trials (RCTs) involving 9168 stroke survivors within 1 year of their stroke.
  • Primary outcome: disability score or independence.
  • Funding: Stroke Research Network, UK.

Key results

  • No significant difference was observed between SSRI and placebo in:
    • disability score (standardised mean difference [SMD], −0.01; 95% CI, −0.09 to 0.06; P=.75),
    • independence (risk ratio [RR], 1.00; 95% CI, 0.91-1.09; P=.99; I2, 78.32%),
    • neurological deficit score (SMD, −0.30; 95% CI, −0.63 to 0.04; P=.08) and
    • total number of death (RR, 0.99; 95% CI, 0.79-1.25; P=.95) and seizures (RR, 1.47; 95% CI, 0.99-2.18; P=.06).
  • SSRIs vs placebo group had significant reduction in depression severity (SMD, 0.11; 95% CI, 0.19-0.04; P=.07; I2, 69.08%).
  • At the end of treatment, the risk for depression reduced in SSRI vs placebo group (RR, 0.78; 95% CI, 0.66-0.92).
  • Risk for gastrointestinal side effects was higher in the SSRIs vs placebo group (RR, 2.19; 95% CI, 1.00-4.76; P=.05).

Limitations

  • Heterogeneity.
  • Risk of bias.

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