Mortensen Janne Kaergaard, Andersen Grethe
Aarhus University Hospital, Department of Neurology , Nørrebrogade 44, 8000 Aarhus C , Denmark +4578463335 ; +4578463300 ;
Expert Opin Drug Saf. 2015 Jun;14(6):911-9. doi: 10.1517/14740338.2015.1033396. Epub 2015 Apr 2.
Selective serotonin reuptake inhibitors (SSRIs) are widely used for psychiatric complications after stroke. Studies have indicated additional effects, and SSRIs could potentially be used as enhancers of stroke recovery. However, beneficial effects should be weighed against potential adverse effects. In particular, the possible association with cerebrovascular events has raised concern.
We review the literature on cerebrovascular events associated with SSRI treatment after stroke. The possible beneficial effects of SSRI treatment for stroke recovery and survival, and potential safety concerns, are discussed.
Evidence suggests that SSRIs may enhance stroke recovery. Most studies on cerebrovascular risk are from non-stroke populations and little is known about recurrent events and mortality post-stroke. In non-stroke populations treatment has been associated with increased risk of intracerebral and intracranial hemorrhage; however the absolute risk is low. The association between SSRIs and ischemic stroke is less clear. Randomized stroke trials indicate that treatment is safe and well tolerated, and the most common side effects are often benign and transient. The trials are small however and not powered to detect potential differences in cerebrovascular events. We await several ongoing large randomized trials before SSRIs can be recommended as a routine pharmacotherapy in stroke recovery.
选择性5-羟色胺再摄取抑制剂（SSRIs）被广泛用于治疗中风后的精神并发症。研究表明其具有其他作用，SSRIs可能有促进中风恢复的功效。然而，必须权衡其有益效果与潜在的不良反应。尤其是，其与脑血管事件的可能关联引发了关注。
我们回顾了关于中风后与SSRI治疗相关脑血管事件的文献。讨论了SSRI治疗对中风恢复和生存的可能有益效果以及潜在的安全问题。
有证据表明SSRIs可能促进中风恢复。大多数关于脑血管风险的研究来自非中风人群，对于中风后的复发事件和死亡率了解甚少。在非中风人群中，治疗与脑内和颅内出血风险增加相关；然而，绝对风险较低。SSRIs与缺血性中风之间的关联尚不清楚。随机中风试验表明治疗是安全且耐受性良好的，最常见的副作用通常是良性且短暂的。然而，这些试验规模较小，没有足够的能力检测脑血管事件中的潜在差异。在SSRIs能够被推荐作为中风恢复的常规药物治疗之前，我们还需等待几项正在进行的大型随机试验结果。
