Zhou Shaojiong, Liu Shuo, Liu Xiaoqiang, Zhuang Weiduan
Shantou University Medical College.
Neurology Department, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China.
Medicine (Baltimore). 2020 Feb;99(6):e19062. doi: 10.1097/MD.0000000000019062.
The efficacy and safety of selective serotonin reuptake inhibitors (SSRIs) for functional independence and depression prevention in early stage of post-stroke (within 1 month after stroke onset) are still unclear.
Relevant randomized controlled trials (RCTs) comparing early SSRIs therapy with placebo were sought from PubMed, Cochrane Library, Medline, and Embase. Primary outcomes were functional independence and depression occurrence. Secondary outcomes contained the improvement of Fugl-Meyer motor scale (FMMS) score and adverse events. We used fixed or random effects model to pooled effect estimates. And we chose risk ratio (RR) or mean differences (MDs) with the 95% confidence intervals (CIs) for data analysis.
We included 10 RCTs with total 5370 patients. The outcome of functional independence showed no significant difference between SSRIs and placebo group (RR, 1.28; 95% CI, 0.96-1.72; P = .10; I = 92%). However, depression occurrence differed significantly between these 2 groups, which favored SSRIs group (RR, 0.78; 95% CI, 0.67-0.90; P = .001; I = 23%). In addition, we observed that the side effects of SSRIs were seizure and nausea. Except psychiatric disorders/insanity rate was less in SSRIs group than placebo group (RR, 0.66; 95% CI, 0.48-0.90; P = .009) (I = 0%), other adverse events were revealed non-significant in our meta-analysis.
Our meta-analysis revealed that early SSRIs therapy were effective to prevent post-stroke depression. However, SSRIs did not improve patient's post-stroke functional independence. In addition to increase the occurrence of seizure and nausea, SSRIs were relatively safe.
选择性5-羟色胺再摄取抑制剂（SSRIs）在脑卒中早期（卒中发病后1个月内）对功能独立性和预防抑郁的疗效及安全性仍不明确。
从PubMed、Cochrane图书馆、Medline和Embase中检索比较早期SSRIs治疗与安慰剂的相关随机对照试验（RCTs）。主要结局为功能独立性和抑郁的发生。次要结局包括Fugl-Meyer运动量表（FMMS）评分的改善和不良事件。我们采用固定或随机效应模型进行合并效应估计。数据分析时选择风险比（RR）或均值差（MDs）及95%置信区间（CIs）。
我们纳入了10项RCTs，共5370例患者。功能独立性结局显示，SSRIs组与安慰剂组之间无显著差异（RR，1.28；95%CI，0.96-1.72；P = 0.10；I = 92%）。然而，这两组之间抑郁的发生有显著差异，SSRIs组更具优势（RR，0.78；95%CI，0.67-0.90；P = 0.001；I = 23%）。此外，我们观察到SSRIs的副作用为癫痫发作和恶心。除了SSRIs组的精神障碍/精神错乱发生率低于安慰剂组（RR，0.66；95%CI，0.48-0.90；P = 0.009）（I = 0%）外，其他不良事件在我们的荟萃分析中无显著差异。
我们的荟萃分析表明，早期SSRIs治疗对预防卒中后抑郁有效。然而，SSRIs并未改善患者卒中后的功能独立性。除了增加癫痫发作和恶心的发生率外，SSRIs相对安全。
