“I think the study is quite exciting,” says Robert Robinson, MD, a neuropsychiatrist who is the Paul Penningroth chair of psychiatry at the University of Iowa. “It is the largest trial to date that has demonstrated that the use of an antidepressant medication can augment the physical recovery from stroke.”
The study is part of a small but growing cache of evidence that suggests that SSRI antidepressant medications such as Celexa, Lexapro, Paxil, Prozac, and Zoloft may help stroke patients not simply by relieving mood symptoms, which can hinder recovery in their own right by causing people to feel hopeless and tired, but also by helping neurons grow and re-establish connections in the brain that are vital for physical functioning.
If further research continues to confirm the finding, experts say SSRI antidepressants would be only the second kind of drug therapy found to offer any benefit to stroke patients.
The most common drug, a clot buster, must be administered within hours of the stroke to be effective; and studies suggest up to 90% of people who have strokes don’t get to the hospital fast enough to benefit from it.
Significant Improvement in Function
The new study, which is published in The Lancet, looked at improvements in paralysis and weakness in 118 ischemic stroke patients in France who were randomly assigned to receive either 20 milligrams of Prozac or a placebo each day for three months beginning 5-10 days after stroke onset. All study participants received physical therapy.
On average, after 90 days, patients in the Prozac group had improved 34 points on a 100-point stroke symptom scale. Patients in the placebo group, on the other hand, saw a 24-point improvement. The improvement remained even when researchers adjusted the study results to exclude patients who’d developed depression. The study was sponsored by the French government.
Experts say the finding means SSRI antidepressant medications could make the difference between someone needing help to get out of bed or to walk and being able to do those daily activities on their own.
“We’re not talking about a couple of points on the scale as happens in Alzheimer’s disease where the improvement in barely noticeable,” says Robinson, who co-authored an editorial on the study. “We’re talking about patients who are a whole category improved. We’re talking about clinically and significantly bigger improvement for the patient and their family.”
Robinson has conducted similar studies, one with the drug Prozac and other with the drug Lexapro, which followed patients for up to a year after their strokes.
“Even when you stop the drug, the recovery continues for at least another nine months,” he says.
How Antidepressants May Heal the Brain
Robinson says he believes that SSRI antidepressants may help to heal the brain after a stroke in two ways.
“If you have a stroke, the glial cells, the white cells in the brain, release these inflammatory proteins,” Robinson says. “Antidepressants decrease the amount of inflammation produced by the stroke.”
The drugs then encourage the growth of new nerve cells, called neurons, and increase the connections between nerve cells. These actions essentially rewire the brain, making it better able to connect with the rest of the body.
SSRI Antidepressants Relatively Safe, Inexpensive
Roger Bonomo, MD, director of stroke care at Lenox Hill Hospital in New York City, who was not involved in the study, notes that many people are already given antidepressants after their strokes, though they are usually prescribed to treat depression, which can be a common problem after brain injury.
“The treatment of people with strokes with antidepressants is not so new. It’s the idea that you can help their motor function is what’s new here,” Bonomo says.
“I think what’s also important about the subject is that it means that people probably need medication,” he says. “Talk therapy doesn’t seem to be sufficient.”
He says SSRI antidepressants have relatively few side effects, so they are low risk even for people with cardiovascular disease.