scholarly journals Selective Serotonin Reuptake Inhibitors for the Prevention of Post-Stroke Depression: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 10 (24) ◽  
pp. 5912
Author(s):  
Daniel Richter ◽  
Jeyanthan Charles James ◽  
Andreas Ebert ◽  
Aristeidis H. Katsanos ◽  
Lisa Mazul-Wach ◽  
...  

There are controversial data on the efficacy and safety profile of selective serotonin reuptake inhibitors (SSRIs) to prevent post-stroke depression (PSD). We performed a systematic search in MEDLINE and SCOPUS databases to identify randomized-controlled trials questioning the use of early SSRI therapy in the post-stroke population and its effect on PSD incidence. We included 6 studies with 6560 participants. We extracted the data on PSD occurrence in association with the treatment arm (SSRI versus placebo), as reported by each study. For safety analysis, we extracted the information on adverse events. A random-effects model was used to calculate the pooled relative risk estimates. Early SSRI therapy was associated with a significant reduction of PSD occurrence compared to placebo (10.4% versus 13.8%; relative risk: 0.75 [95% CI, 0.66–0.86]; absolute risk reduction: 3.4%). SSRI therapy increases the risk of bone fracture (RR 2.28 [95% CI, 1.58–3.30]) and nausea (RR 2.05 [95% CI, 1.10–3.82]) in the post-stroke population. Considering the risk-benefit ratio of early SSRI therapy in the post-stroke population, future research should identify high-risk patients for PSD to improve the risk-benefit consideration of this therapy for use in clinical practice.

2020 ◽  
Vol 12 (6) ◽  
pp. 110-116
Author(s):  
S. V. Kotov ◽  
E. V. Isakova ◽  
Yu. V. Egorova

Stroke is the leading cause of disability in adults. Depression after a stroke is detected in one third of patients, complicating physical rehabilitation, worsening functional outcome, increasing mortality rates. The question of the use of antidepressants in the treatment of post-stroke depression is currently not completely resolved, there is no consensus on the most optimal drug. The drugs of choice are selective serotonin reuptake inhibitors, the use of tricyclic antidepressants is possible. A number of clinical studies indicate the effectiveness of selective serotonin reuptake inhibitors in the treatment of post-stroke depression, including through mechanisms including increased neuroplasticity and stimulation of neurogenesis, while others disprove their effectiveness. The article presents a clinical case of the use of vortiroxetin in the patient’s neurorehabilitation in the early recovery period of a stroke, its safety and positive effect are shown.


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