Richter Daniel, Charles James Jeyanthan, Ebert Andreas, Katsanos Aristeidis H, Mazul-Wach Lisa, Ruland Quirin, Gold Ralf, Juckel Georg, Krogias Christos
Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, 44791 Bochum, Germany.
Department of Psychiatry, Ruhr-University Bochum, LWL-Klinik, 44791 Bochum, Germany.
J Clin Med. 2021 Dec 16;10(24):5912. doi: 10.3390/jcm10245912.
There are controversial data on the efficacy and safety profile of selective serotonin reuptake inhibitors (SSRIs) to prevent post-stroke depression (PSD). We performed a systematic search in MEDLINE and SCOPUS databases to identify randomized-controlled trials questioning the use of early SSRI therapy in the post-stroke population and its effect on PSD incidence. We included 6 studies with 6560 participants. We extracted the data on PSD occurrence in association with the treatment arm (SSRI versus placebo), as reported by each study. For safety analysis, we extracted the information on adverse events. A random-effects model was used to calculate the pooled relative risk estimates. Early SSRI therapy was associated with a significant reduction of PSD occurrence compared to placebo (10.4% versus 13.8%; relative risk: 0.75 [95% CI, 0.66-0.86]; absolute risk reduction: 3.4%). SSRI therapy increases the risk of bone fracture (RR 2.28 [95% CI, 1.58-3.30]) and nausea (RR 2.05 [95% CI, 1.10-3.82]) in the post-stroke population. Considering the risk-benefit ratio of early SSRI therapy in the post-stroke population, future research should identify high-risk patients for PSD to improve the risk-benefit consideration of this therapy for use in clinical practice.
关于选择性5-羟色胺再摄取抑制剂（SSRI）预防卒中后抑郁（PSD）的疗效和安全性存在争议性数据。我们在MEDLINE和SCOPUS数据库中进行了系统检索，以确定对卒中后人群早期使用SSRI治疗及其对PSD发生率影响提出质疑的随机对照试验。我们纳入了6项研究，共6560名参与者。我们提取了每项研究报告的与治疗组（SSRI与安慰剂）相关的PSD发生数据。为进行安全性分析，我们提取了不良事件信息。采用随机效应模型计算合并相对风险估计值。与安慰剂相比，早期SSRI治疗与PSD发生率显著降低相关（10.4%对13.8%；相对风险：0.75[95%CI，0.66 - 0.86]；绝对风险降低：3.4%）。SSRI治疗会增加卒中后人群骨折风险（RR 2.28[95%CI，1.58 - 3.30]）和恶心风险（RR 2.05[95%CI，1.10 - 3.82]）。考虑到卒中后人群早期SSRI治疗的风险效益比，未来研究应识别PSD的高危患者，以改善该治疗在临床实践中风险效益的考量。
