Is Fluoxetine Good for Subacute Stroke? A Meta-Analysis Evidenced From Randomized Controlled Trials

Area of Science:

• Neurology
• Pharmacology
• Clinical Research

Background:

• Fluoxetine, used for mental disorders, is explored for post-stroke neurological recovery.
• Previous studies suggest potential benefits in motor and functional recovery after stroke.
• This meta-analysis investigates fluoxetine's efficacy and safety in subacute stroke patients.

Approach:

• Systematic literature search of PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs).
• Data analysis using Review Manager 5.3 with fixed effects model for risk ratio (RR) and standardized mean difference (SMD).
• Inclusion of nine RCTs pooling data from 6,788 patients up to October 2020.

Key Points:

• Fluoxetine did not significantly alter the modified Rankin Scale (mRS) scores.
• Significant improvements were observed in the Fugl-Meyer Motor Scale (FMMS) and Barthel Index (BI).
• A trend towards improvement in the National Institutes of Health Stroke Scale (NIHSS) was noted, alongside a reduction in new-onset depression and antidepressant use.

Conclusions:

• Fluoxetine shows efficacy in improving motor and daily function recovery post-stroke, evidenced by FMMS and BI improvements.
• It did not demonstrate significant benefits for overall functional outcome (mRS) or neurological deficit severity (NIHSS).
• Observed differences may stem from trial heterogeneities including treatment duration, scale sensitivity, patient demographics, and inclusion timing.