So it seems antidepression meds do not increase motor recovery. Ask your doctor to analyze all sets of research to determine which way to go. Well, fuck, the Rankin scale has nothing objective in it at all except for 6 - death. Using the Rankin scale is stupid, it has very limited discriminatory power and is not objective.
Common antidepressant can help stroke patients improve movement and coordination Sept. 2015
Antidepressants may help people recover from stroke even if they are not depressed Jan. 2013
Effects of fluoxetine(SSRI) on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial
Open access funded by Department of Health UK
Summary
Background
Results
of small trials indicate that fluoxetine might improve functional
outcomes after stroke. The FOCUS trial aimed to provide a precise
estimate of these effects.
Methods
FOCUS
was a pragmatic, multicentre, parallel group, double-blind, randomised,
placebo-controlled trial done at 103 hospitals in the UK. Patients were
eligible if they were aged 18 years or older, had a clinical stroke
diagnosis, were enrolled and randomly assigned between 2 days and 15
days after onset, and had focal neurological deficits. Patients were
randomly allocated fluoxetine 20 mg or matching placebo orally once
daily for 6 months via a web-based system by use of a minimisation
algorithm. The primary outcome was functional status, measured with the
modified Rankin Scale (mRS), at 6 months. Patients, carers, health-care
staff, and the trial team were masked to treatment allocation.
Functional status was assessed at 6 months and 12 months after
randomisation. Patients were analysed according to their treatment
allocation. This trial is registered with the ISRCTN registry, number
ISRCTN83290762.
Findings
Between
Sept 10, 2012, and March 31, 2017, 3127 patients were recruited. 1564
patients were allocated fluoxetine and 1563 allocated placebo. mRS data
at 6 months were available for 1553 (99·3%) patients in each treatment
group. The distribution across mRS categories at 6 months was similar in
the fluoxetine and placebo groups (common odds ratio adjusted for
minimisation variables 0·951 [95% CI 0·839–1·079]; p=0·439). Patients
allocated fluoxetine were less likely than those allocated placebo to
develop new depression by 6 months (210 [13·43%] patients vs 269 [17·21%]; difference 3·78% [95% CI 1·26–6·30]; p=0·0033), but they had more bone fractures (45 [2·88%] vs
23 [1·47%]; difference 1·41% [95% CI 0·38–2·43]; p=0·0070). There were
no significant differences in any other event at 6 or 12 months.
Interpretation
Fluoxetine
20 mg given daily for 6 months after acute stroke does not seem to
improve functional outcomes. Although the treatment reduced the
occurrence of depression, it increased the frequency of bone fractures.
These results do not support the routine use of fluoxetine either for
the prevention of post-stroke depression or to promote recovery of
function.
Funding
UK Stroke Association and NIHR Health Technology Assessment Programme.
Introduction
Each
year, stroke affects around 9 million people worldwide for the first
time and results in long-term disability for around 6·5 million people.
Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is used to
treat depression and emotional lability after stroke. Many clinical and
preclinical studies have suggested that SSRIs might improve outcomes
after stroke through a range of mechanisms, which include enhancing
neuroplasticity and promoting neurogenesis. In 2011, the results of the
FLAME (FLuoxetine for motor recovery After acute ischaeMic strokE) trial
indicated that fluoxetine enhanced motor recovery.
In this double-blind, placebo-controlled, multicentre trial, 118
patients with ischaemic stroke and unilateral motor weakness, and a
median National Institutes of Health Stroke Scale (NIHSS) score of 13,
were randomly allocated between 5 and 10 days after stroke onset to
receive fluoxetine 20 mg daily or placebo for 3 months. At day 90, the
improvement from baseline in the Fugl-Meyer motor score was
significantly greater in the fluoxetine group than in the placebo group.
Additionally, the proportion of patients who were independent in daily
living (with a modified Rankin Scale [mRS] score of 0–2) was
significantly higher in the fluoxetine group than in the placebo group
(26% vs 9%, p=0·015). More participants were free from depression at 3 months in the fluoxetine group than in the placebo group (93% vs 71%; p=0·002). A subsequent Cochrane systematic review
of SSRIs for stroke recovery identified 52 randomised controlled trials
of SSRIs versus controls (in 4060 patients), but no others tested the
effect of fluoxetine on functional outcomes measured with the mRS. The
findings of the Cochrane review suggested that SSRIs might reduce
post-stroke disability, although this estimate was based on a
meta-analysis done across various measures of function and greater
effects were seen if studies with increased risk of bias were retained
and patients with depression were included. Although promising, data
from the FLAME trial and the Cochrane review were not sufficiently
compelling to alter stroke treatment guidelines or to alleviate concerns
that any possible benefits might be offset by serious adverse
reactions.
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