SUNDAY, Jan. 9 (HealthDay News) -- Stroke patients given the
antidepressant fluoxetine (best known by the brand name of Prozac)
appear to regain more muscle function than other recovering stroke
sufferers, French researchers have found.
Not surprisingly, patients on the generic Prozac were also less
susceptible to depression after their stroke, the study found.
Paralysis and/or weakness on one side of the body are the most
common disabilities after stroke. Earlier trials have suggested
that antidepressants might help improve motor recovery after
stroke, probably by increasing the level of serotonin in the
central nervous system, the researchers explained.
Lead researcher Dr. Francois Chollet said the study "opens a new
pathway" in the treatment of the leading form of stroke, in which a
blockage in a blood vessel is the cause of the attack. Chollet,
from the University Hospital of Toulouse and INSERM, noted that
Prozac also appears to target neurons themselves rather than trying
to re-open arteries, as many other stroke medications do.
The report is published in the Jan. 9 online edition of
The Lancet Neurology.
Stroke is a major cause of death and long-term disability for
Americans, so any agent that helps boost functionality is of great
benefit. In the new study, Chollet's team randomly assigned 118
ischemic (blockage) stroke patients left with paralysis or weakness
on one side of the body to either 20 milligrams of generic Prozac
or placebo per day starting 5 to 10 days after their stroke.
After three months of follow-up, patients taking generic Prozac
had improved their score on a measure of motor function by 34
points over their initial test, compared with a 24.3-point
improvement among those receiving placebo, the researchers
Moreover, this statistically significant improvement was seen in
both arm and leg function, Chollet's group said.
The improvement meant that more patients in the generic Prozac
group were able to live independently than patients in the placebo
group, the researchers noted.
The drug -- from the same class of selective serotonin reuptake
inhibitors (SSRIs) that includes Celexa, Paxil and Zoloft -- was
well-tolerated and side effects were mild. However, nausea,
diarrhea, and abdominal pain were more common among patients taking
the antidepressant, and two of those patients suffered serious
The generic form of Prozac is also relatively cheap now, at
about 30 cents per pill.
And there was an added bonus: patients taking generic Prozac
were less likely to be depressed, which suggests that giving the
antidepressant after a stroke could prevent depression, the
But Chollet noted that remaining questions persist. "How long
should be the treatment period? What is the long-term effect? Can
other neurological functions, such as language and vision, be
improved in a similar way? Can we observe a similar action in [the
rarer form of] hemorrhagic strokes? These question will have to be
addressed in a short while," he said.
He and the other researchers reported no conflicts of
Dr. Robert G. Robinson, professor and head of the department of
psychiatry at the University of Iowa and coauthor of an
accompanying journal editorial, said that "the implications of the
study are very positive."
Robinson noted that a study that he participated in found
similar results. He believes that antidepressants may aid in
producing new nerve cells in the brain and also help in creating
new connections between these cells. In addition, antidepressants
may also help in preventing the inflammation seen in stroke, he
"This study raises the question, should all patients who have a stroke be given antidepressant medication?" Robinson said. "Given the large number of people who have stroke each year, you are talking about a huge paradigm shift in the care of stroke patients. But this finding clearly raises that question."
To find the answer, "a large definitive trial" needs to be done
that compares the use of antidepressants and placebo in many
patients, Robinson said. He and his co-author also noted that the
trial should investigate whether the effects of the treatment
persist over time.
But another expert suggested that generic Prozac's role in
lowering post-stroke depression might account for the improvement
in physical function simply by promoting more effective
participation in physical therapy.
Dr. Larry B. Goldstein, director of the Duke University Stroke
Center, noted that the study failed to control for the intensity or
type of physical therapy that patients received after the
Those who received the antidepressant tended to be less
depressed and thus might have more effectively participated in
physical therapy, he reasoned.
"Because other studies show that more intensive physical therapy is associated with better recovery, it is possible that the antidepressant effect, rather than an effect on the recovery process itself, might explain the difference," Goldstein said.
For more information on stroke, visit the
U.S. National Institute of Neurological Disorders and
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