Efficacy and tolerability of selective serotonin reuptake inhibitors on promoting motor recovery after stroke:meta-analysis of randomized controlled trials

ABSTRACT

Introduction

Although experimental data suggest that Selective serotonin reuptake inhibitors (SSRIs) may improve motor recovery after stroke, the results from clinical studies are conflicting.

Areas Covered

Six international electronic databases (Cochrane, PubMed, Embase, Web of Science, CINAHL, and PsycINFO) and four Chinese electronic databases (CBM, CNKI, WanFang Data, and VIP) were systematically searched up to April 2021. Co-primary outcomes were motor function and tolerability. Secondary outcomes included disability, neurological function, continuous depression scores, and adverse events.

Results

25 randomized controlled trials including 4777 participants were identified. Pooled analyses found SSRIs significantly improved motor function [standardized mean differences (SMD), 0.72; 95% CI, 0.46 to 0.99], disability (SMD, 0.79; 95% CI, 0.51 to 1.06), neurological function (SMD, −0.58; 95% CI, −0.77 to −0.39) and continuous depression scores (SMD, −0.36; 95% CI, −0.70 to −0.02). SSRIs were associated with increased seizure (risk ratio, 9.00; 95% CI, 1.69 to 47.91) and gastrointestinal side effects (risk ratio, 2.26; 95% CI, 1.56 to 3.28), but similar risk of all-cause discontinuations when compared with the control group (risk ratio, 1.11; 95% CI, 0.79 to 1.56).

Expert Opinion

SSRIs are effective and well-tolerated to promote motor recovery after stroke, but may increase the risk of seizures and gastrointestinal adverse effects.

KEYWORDS:

• Efficacy
• meta-analysis
• stroke
• selective serotonin reuptake inhibitors
• motor recovery

Article highlights

• Motor deficit is the prominent impairment caused by stroke that affects quality of life and activities of daily living.

• Previous studies have shown conflicting results on the effect of SSRIs on promoting motor recovery after stroke.

• Our report is the first to focus exclusively on patients with post-stroke motor deficits and shows that SSRIs significantly improve post-stroke motor function.

• There may be a higher likelihood to increase the risk of seizure and gastrointestinal side effects.

• Subgroup analyses detected that patients with hemorrhagic stroke and those with early time intervals after stroke seemed to benefit the most.

Declaration of interests

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

D Su, Y Zhang and H Luo conceived and designed the study. D Su, Y Zhang, D Shao, F Xu, M Dong and Y Hu selected the articles and extracted the data. D Su, Y Zhang and L Zhao analysed the data. D Su, Y Zhang and A Wang wrote the first draft of the manuscript. D Su, Y Zhang and H Luo interpreted the data and wrote the final version. All authors read and approved the final submitted paper.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This work was supported by the Natural Science Foundation of China (NSFC, #82001434), the Natural Science Foundation of Chongqing (cstc2020jcyj-msxmX0149), and the Health Appropriate Technology Promotion Project of Chongqing (2016jstg014).