Melissa Healy, Los Angeles Times
9:42 AM EST, January 11, 2011
Stroke victims who took the antidepressant Prozac for three months following the interruption of blood flow to the brain regained more mobility, and showed lower rates of depression, than those given a placebo pill, a new study has found.
The European trial of antidepressants in the treatment of stroke was the largest of its kind, and was published online this week by the journal Lancet Neurology. Fewer subjects taking the antidepressant developed depression--a common occurrence in stroke's wake, and one that increases the risk of dying. But , even when subjects taking the medication developed depression, the study found, they were more likely to recover lost movement on the affected side, the study found.
The FLAME trial (short for Fluoxetine for Motor Recovery After Acute Ischemic Stroke) holds out a promising option for patients who do not reach the hospital quickly enough to receive clot-busting medication, and who lose movement or feeling in the wake of a stroke. It found that after three months, subjects who took the antidepressant fluoxetine (better known by its commercial name, Prozac) scored, on average, 10 points better on a 100-point measure of mobility and sensation than similarly affected subjects who took a dummy pill.
Of the 113 subjects who completed the FLAME trial, 57 began taking Prozac between five and 10 days after being hospitalized for stroke, and continued on the medication for at least three months, at which point their levels of mobility were assessed.
Fluoxetine is among the class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs. In some studies, SSRIs have been shown to help protect the brain from injury, to promote the regeneration of brain cells in areas crucial to learning and memory, and to cause heightened activity and sensitivity in brain regions that govern movement.
Dr. Jeffrey L. Saver, director of UCLA's Stroke Center, said that the antidepressant tested in the trial, which boosts levels of the chemical serotonin in the brain, appears to have improved outcomes in several ways: by lifting many patients' moods in the wake of a stroke, it likely boosted optimism and participation in rehabilitation activities; and by facilitating brain-cell function in stroke's wake, the medication likely helped patients in rehabilitation to "rewire" their brains to recover or compensate for lost function.
"These findings support wider use of SSRIs among patients in the first three months following moderate to major stroke," said Saver. "This is an important study," he said.
A commentary accompanying the FLAME trial's findings noted that the practice of prescribing antidepressants in the wake of an ischemic stroke (or one that has blocked blood flow to the brain) is gaining ground. At the same time, Drs. Robert G. Robinson and Harold P. Adams, of the University of Iowa's departments of psychiatry and neurology, respectively, cited the findings' "enormous potential....to change clinical practice," and called for further work on the role of medications in enhancing post-stroke rehabilitation.
Depression is much more common among patients who have survived a stroke, and likely for many reasons, appears to lead to an increase in the risk of death in its wake. The authors of the FLAME study, researchers from the French National Program for Clinical Research, said taking antidepressants in the wake of a stroke appeared to have the power to prevent the onset of depression, as well as to improve mobility. But whether patients would develop depression later, as well as whether preventing depression during rehabilitation would result in patients surviving longer, remains to be tested by trials that follow stroke patients for longer than three months.
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