The Efficacy and Tolerability of Selective Serotonin Reuptake Inhibitors for Motor Recovery in Non-depressed Patients After Acute Stroke: A Meta-Analysis.

To explore the efficacy and tolerability of selective serotonin reuptake inhibitors (SSRIs) for motor recovery in non-depressed patients after acute stroke. According to the predefined retrieval strategy, multiple electronic databases were searched for randomized controlled trials (RCTs) that met the inclusion criteria. The primary efficacy outcome was measured by Fugl-Meyer Motor Scale (FMMS) score and the indicators of tolerability included withdrawal rate and the incidence of adverse events (AEs). 10RCTs were included, the pooled analyses showed patients who received fluoxetine (endpoint: MD = 21.17, 95% CI 14.13-28.21, < 0.00001; mean change: MD = 16.27, 95% CI 10.05-22.50, < 0.00001) and citalopram (endpoint: MD = 22.93, 95% CI 11.13-34.73, = 0.0001; mean change: MD = 24.06, 95% CI 10.47-37.65, = 0.0005) experienced greater improvement in FMMS score. There was no evident difference in total withdrawal rate (fluoxetine: OR = 1.11, 95% CI 0.90-1.27, = 1.38; citalopram: OR = 0.94, 95% CI 0.69-1.28, = 0.71; escitalopram: OR = 0.87, 95% CI 0.58-1.28, = 0.47) between two groups. Besides, the incidence of hyponatremia (OR = 2.01, 95% CI 1.16-3.50, = 0.01), seizure (OR = 1.46, 95% CI 1.03-2.08, = 0.04) and fracture (OR = 2.34, 95% CI 1.61-3.40, < 0.00001) in the fluoxetine group was higher than in the placebo group. Fluoxetine and citalopram can promote motor recovery in non-depressed patients with acute stroke, but it is necessary to pay attention to the possible AEs of fluoxetine, such as hyponatremia, seizure and fracture. PROSPERO, identifier [CRD42021227452].