Antidepressants no use in stroke

GPs should be wary of prescribing antidepressants to patients following stroke in the hope that they will improve, say experts.

The warning follows US research suggesting that a 12-week course of fluoxetine or nortriptyline can improve long-term executive function.

At a 21-month follow-up, patients who were prescribed antidepressants showed significant improvement in executive function, but those given placebo showed deterioration.

The drugs may boost executive function recovery by affecting monoaminergic nuclei in frontal cortical–subcortical circuits that control executive function, say the University of Iowa team.

Alternatively, antidepressants may boost neurogenesis.

But Professor Allan House, an expert in depression after stroke at the University of Leeds, said: ‘It is a very interesting theory but this research doesn’t help one way or another.’

Although 92 people were randomly assigned to an antidepressant or placebo six months after stroke, only 36 completed all evaluations during the 21-month follow-up.

‘They actually account for just over a third of people who entered this trial. Loss to follow-up is a major cause of bias,’ said Professor House.

A Cochrane Review into antidepressants after stroke showed the drugs had little effect beyond elevating mood, he added.

There are concerns about increased risk of falls, gastrointestinal complications and risk of epilepsy in elderly stroke patients on antidepressants, said Professor House.

Dr David Taylor, chief pharmacist at the South London and Maudsley Hospital, agreed there were concerns over giving antidepressants to stroke patients.

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