Key result
Early SSRI therapy cuts post-stroke depression ~25% vs placebo but increases bone fractures and nausea.
Why the study?
There are controversial data on the efficacy and safety profile of SSRIs to prevent post-stroke depression.
Does early SSRI therapy reduce the incidence of post-stroke depression in post-stroke patients?
Meta-Analysis (n=6,560)
Double-blind
Randomized
Does early SSRI therapy reduce the incidence of post-stroke depression in post-stroke patients?
Relative Risk: 0.75 (95% CI 0.66–0.86)
Absolute Event Rate: 10.4% vs 13.8%
Absolute Risk Reduction: 3.4%
Early SSRI therapy reduces the risk of post-stroke depression but increases the risk of bone fractures and nausea, highlighting the need for careful patient selection.
Supports early SSRI prophylaxis to cut PSD incidence; leaves open optimal high-risk patient selection balancing fracture and nausea risks.
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.
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Richter et al. (2021) conducted a meta-analysis in Post-stroke depression (n=6,560). Selective Serotonin Reuptake Inhibitors (SSRIs) vs. Placebo was evaluated on Depression occurrence at follow-up (RR 0.75, 95% CI 0.66-0.86). Early SSRI therapy significantly reduced the incidence of post-stroke depression compared to placebo (10.4% vs 13.8%; RR 0.75), but increased the risk of bone fractures and nausea.
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