New Study Finds Limited Effectiveness for Antidepressants After Stroke

Peter Simons
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A new study, just published in The Lancet, studied the effect of fluoxetine (brand name: Prozac) in people who had just had a stroke. The researchers found that although antidepressants had a slight short-term effect on reducing the likelihood of depression diagnosis, there was no long-term improvement, nor any improvement in motor functioning. In addition, the risk of adverse events, particularly bone fractures, was significantly increased.

“Fluoxetine 20 mg given daily for 6 months after an acute stroke does not seem to improve functional outcomes,” the researchers write. “Although the treatment reduced the occurrence of depression, it increased the frequency of bone fractures. These results do not support the routine use of fluoxetine either for the prevention of post-stroke depression or to promote recovery of function.”

Photo Credit: Max Pixel

Previous smaller studies had suggested that antidepressants might be useful for improving functional outcomes after stroke—such as enhancing motor recovery (the ability to move). The current study was known as the FOCUS (Fluoxetine Or Control Under Supervision) trial, and was designed as a large-scale study to determine whether this was an accurate finding.

The study included 3127 patients from 107 hospitals in the UK, most of whom were around 70 years old, and all of whom had recently had a stroke. Half were randomly assigned to receive fluoxetine, while the other half received a placebo (a pill designed not to have an effect) with the appearance of fluoxetine.

The antidepressants appeared better than placebo for improving depression after the first six months of treatment. 210 people taking antidepressants ended up with a depression diagnosis, while 269 of those in the placebo group received the diagnosis.

However, this effect was completely gone by the 12-month mark. After a year, people who took antidepressants were no less likely than those in the placebo group to receive the depression diagnosis. Additionally, even at the six-month mark, there was no difference in functional outcomes such as motor recovery, strength, hand ability, memory, communication, and emotion.

Also, at the six-month mark, people who took fluoxetine were about twice as likely to develop bone fractures. 45 people who took the antidepressant developed bone fractures, compared with 23 of those in the placebo group.

The researchers write that their results indicate that fluoxetine does not appear to improve functional outcomes after stroke, and although it may reduce depression in the short-term, it does not appear to have a significant long-term effect. In addition, the risk of increased bone fractures is high—which is a danger in the aging population.

 

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Focus Trial Collaboration (2019). Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. Lancet, 393, 265-274. Published online December 5, 2018. http://dx.doi.org/10.1016/ S0140-6736(18)32823-X (Link)

9 COMMENTS

  1. I’m wondering about the point in doing this. Stroke patients are probably likely to be depressed if they notice significant impairment of functioning- is this alleged treatment supposed to help this state despite no return of “normal” functioning? Or is it to make you happy, though impaired?
    Or is this a search for new antidepressant markets?

    • …happy but impaired I would say. I would say that it’s the zombie effect that the ones prescribing these damned things to people who’ve suffered a stroke want as the end result. Then the people won’t be angry, demanding, upset etc. and they don’t become a bother to anyone as they sit their separated from their feelings and emotions. Good old Zombie effect!

        • I once worked in a large retirement center/nursing home complex. I watched as Haldol was introduced to “help” the poor older people who were “upset” settle down. What actually was happening was that anyone who spoke up for themselves, called out staff for not doing their jobs, didn’t cooperate with the staff completely (like going to bed at 6:30 pm as the staff wished so that they wouldn’t have anything to do for the rest of the evening) were singled out by the nursing staff for the medical director’s attention. Their suggestion to him for what should be done for these “poor, disturbed older people who needed to calm down for their own good” was a good shot of Haldol! A week later I’d find Mrs. So and so, who was once vital and alive, sitting locked in a Geri chair. This is a reclining chair that has a table across the arms which can be locked to keep the person in the chair. Mrs. So and so would be drooling on herself and not able to carry on a simple conversation.

          Nursing homes have become very lucrative business for the drug companies. So, it doesn’t surprise me at all that they’d try this on people who’d suffered a stroke. The question is who is safe from being drugged at this point? We’re drugging kids, adolescents, older people, people with disabilities. You’re right; eventually it will be a real life scenario of the Body Snatchers.

          • I used to be a staff person for the Long Term Care Ombudsman program in Oregon. I was called once to a nursing home to see a guy whose daughter thought he was “overmedicated.” I could barely get him to open his eyes. He had bruises on his head because he’d walked into the doorframe instead of through the opening in the door. I interviewed the activities director and she told me that a week ago, he’d been hitting a volleyball back and forth with her in the courtyard! The difference: he was now on Risperdal.

            How anyone could call this an “improvement” is beyond my comprehension. It shouldn’t take an outsider coming in to point out that they’ve now disabled a perfectly capable person for nothing but the convenience of the staff.

  2. So……Prozac didn’t help stroke patients…….Gee, I could have predicted this even before they spent all that money doing this study. When are people going to smell the coffee, wake up, and understand that these damned devil’s tic tacs don’t help with anything and can end up causing very bad things to happen?

  3. I bet insecticide wouldn’t help them either.

    But keep giving out SSRI’s as much as possible doctors. Keep a big dish to hand out to visitors like office mints. With any luck you can induce psychotic mania, label them Bipolar 2 and force feed them 3-6 drugs instead of 1 every day till they die.

    Cha ching!