Abstract Details

Title Antidepressant Use for Improving Functional Ischemic Stroke Outcomes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P16 - Poster Session 16 (5:30 PM-6:30 PM)

Poster/Presentation
Number 4-004

Objective To assess the effect of antidepressants on post-ischemic stroke recovery.

Background Antidepressants, namely selective serotonin reuptake inhibitors (SSRIs), have demonstrated efficacy at enhancing post-stroke recovery in trials such as the “FLuoxetine for motor recovery After acute ischaeMic strokE” (FLAME) trial. Other studies, including the “Effects of fluoxetine on functional outcomes after acute stroke” (FOCUS) trial, did not find significant improvements in functional outcomes. In 2015, our institution adopted policy as influenced by the FLAME trial and incorporated SSRIs into standardized care of ischemic stroke patients. We conducted a cohort study on ischemic stroke patient populations before and after the standardized use of SSRIs at our institution to better elucidate the potential positive outcomes attributed to antidepressant use post-stroke.

Design/Methods A retrospectively gathered ischemic stroke population was obtained from an institutional database. Grouping was via intention-to-treat with antidepressant use post-stroke or lack thereof. Patients with severe stroke (NIHSS ≥ 21) were further analysed independently. The primary and secondary outcomes were modified Rankin scale (mRS) and survival over 18 months, respectively. Data was analysed in R using adjusted logarithmic-multivariate models. Adjusted cox proportional hazards models were used to estimate associations between survival and antidepressants.

Results 806 patients (52 severe strokes) received antidepressants post-stroke while 948 (56 severe) did not. The anti-depressant group was more female (56% to 43.5%) and had significantly better survival rates (88% vs. 79%, HR 0.62, p < 0.01) but not mRS scores (2.13 vs 2.24, p = 0.262) by the end of the study period. Among severe stroke cases, those receiving antidepressants showed better survival rates (79% vs. 60%, HR 0.36, p=0.026) and last mRS score (3.9 vs 5, p < 0.01). Analysis controlling for demographics variables retained significance.

Conclusions Anti-depressant use post-stroke may improve functional outcomes in patients suffering severe stroke and may decrease all-cause mortality for strokes of any severity.

Authors/Disclosures
Stephanie Kazi (USD Sanford School of Medicine) PRESENTER	No disclosure on file
Divyajot Sandhu, MD, MBBS (Sanford Medical Center)	Dr. Sandhu has nothing to disclose.
Caleb Heiberger	No disclosure on file
Tej Mehta	No disclosure on file
	No disclosure on file

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Abstract Details