Objective:
To determine if patients admitted with ischemic stroke who were taking selective serotonin reuptake inhibitors (SSRI) at baseline have reduced motor impairment compared to patients not taking an SSRI.
Introduction:
SSRI use may help patients with motor recovery following ischemic stroke. It is not known whether use of this class of medications prior to stroke leads to decreased stroke severity or motor impairment on admission and improved discharge outcome.
Methods:
We retrospectively identified all patients admitted to our institution between 2009 and 2012 with first-ever acute ischemic stroke who were taking an SSRI prior to admission (cases). We collected data on patient demographics, clinical stroke severity as measured by the National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) score, and disposition at discharge. Controls with acute ischemic stroke who were not taking SSRIs prior to admission were matched 2:1 by age and gender to cases.
Results:
Eighty cases (mean age 65 +/- 14 years) were identified, of whom 56.2% were female and 63.7% were Caucasian. Median admission NIHSS was 5 (IQR 2-10), and median length of stay (LOS) was 4 days (IQR 3-7). Compared to controls, cases were more likely to have a pre-stroke diagnosis of depression (43.8% vs 7.5%, p=<0.001) or anxiety (13.8% vs 2.5%, p=0.001). Identification of a cardioembolic etiology was more common in cases (41.2% vs 26.6%, p=0.019). Median total NIHSS scores and NIHSS motor component scores on admission (total 5 vs 4, p=0.69; motor 2 vs 1, p=1.0) or at discharge (total 3.5 vs 2, p=0.67; motor 1 vs 0, p=0.76) were not different between cases and controls. Median LOS was similar for controls (5 days, p=0.65). Discharge to home or acute rehab was similar between groups (p=0.85).
Conclusions:
SSRI use prior to ischemic stroke does not confer a protective effect in reducing initial stroke severity, reducing degree of motor impairment, or improving discharge disposition. Further studies are needed to determine whether there are long-term benefits or other effects.
Selective serotonin reuptake inhibitors to improve outcome in acute ischemic stroke: possible mechanisms and clinical evidence
