- 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.
- 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.
- 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).
- Risk of bias.