Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Int J Stroke. 2023 Mar;18(3):285-295. doi: 10.1177/17474930221124760. Epub 2022 Sep 19.
Apathy is a common and disabling symptom after stroke with no proven treatments. Selective serotonin reuptake inhibitors are widely used to treat depressive symptoms post-stroke but whether they reduce apathetic symptoms is unknown. We determined the effect of fluoxetine on post-stroke apathy in a post hoc analysis of the EFFECTS (Efficacy oF Fluoxetine-a randomized Controlled Trial in Stroke) trial.
EFFECTS enrolled patients ⩾18 years between 2 and 15 days after stroke onset. Participants were randomly assigned to receive oral fluoxetine 20 mg once daily or matching placebo for 6 months. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered at baseline and 6 months. Individual items on this scale were divided into those reflecting symptoms of apathy and depression. Symptoms were compared between fluoxetine and placebo groups.
Of 1500 participants enrolled, complete MADRS data were available for 1369. The modified intention-to-treat population included 681 patients in the fluoxetine group and 688 in the placebo group. Confirmatory factor analysis revealed that apathetic, depressive, and anhedonic symptoms were dissociable. Apathy scores increased in both fluoxetine and placebo groups (both p ⩽ 0.00001). In contrast, fluoxetine was associated with a reduction in depressive scores (p = 0.002).
Post-stroke apathetic and depressive symptoms respond differently to fluoxetine treatment. Our analysis suggests fluoxetine is ineffective in preventing post-stroke apathy.
淡漠是中风后常见且致残的症状，目前尚无有效的治疗方法。选择性 5-羟色胺再摄取抑制剂被广泛用于治疗中风后的抑郁症状，但它们是否能减轻淡漠症状尚不清楚。我们在 EFFECTS（氟西汀疗效随机对照试验）试验的事后分析中，确定氟西汀对中风后淡漠的影响。
EFFECTS 纳入了中风发病后 2 至 15 天的 ⩾18 岁患者。参与者被随机分配接受口服氟西汀 20mg 每日一次或匹配的安慰剂治疗 6 个月。在基线和 6 个月时进行蒙哥马利-阿斯伯格抑郁评定量表（MADRS）。该量表的单项被分为反映淡漠和抑郁症状的项目。比较氟西汀组和安慰剂组之间的症状。
在纳入的 1500 名患者中，1369 名患者有完整的 MADRS 数据。改良意向治疗人群包括氟西汀组 681 例和安慰剂组 688 例。验证性因子分析显示，淡漠、抑郁和快感缺失症状是可分离的。氟西汀组和安慰剂组的淡漠评分均增加（均 p ⩽ 0.00001）。相比之下，氟西汀与抑郁评分降低相关（p=0.002）。
中风后的淡漠和抑郁症状对氟西汀治疗的反应不同。我们的分析表明，氟西汀不能预防中风后的淡漠。
