ischemic stroke
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In a recent study, researchers investigate the safety and efficacy of citalopram for the treatment of ischemic stroke.

Ischemic stroke results from the blockage of blood vessels in the brain, starving the affected regions of oxygen and nutrients. Presently, anti-clotting medications are the only therapies shown to reduce the likelihood and severity of disability post-stroke, though their limited efficacy and availability make exploring other avenues of treatment an attractive prospect.

Recently, selective serotonin reuptake inhibitors such as citalopram (typically used to treat depression) have shown some efficacy in treating motor impairments in ischemic stroke patients. Further research will be required, however, to confirm these findings and determine its potential for the treatment of ischemic stroke-related motor impairments.

In a recent study published in Neurorehabilitation and Neural Repair, researchers investigated the safety and efficacy of citalopram for the treatment of acute ischemic stroke over a three-month period. Adult acute ischemic stroke patients 95 years and under were recruited within seven days of the start of symptoms. Those who experienced severe ischemic stroke and who were depressed took other antidepressants or antipsychotics in the last month, experienced previous stroke-related disability, received anticlotting therapy, or had other disabling diseases were excluded.

All subjects underwent computer tomography brain scans upon hospital admission and had magnetic resonance imaging (MRI) scans the first three days of their stay. Subjects were assigned to receive either 20 mg of citalopram or a placebo daily. Blood samples were collected on day one of the study. Disability assessments were conducted on days 30 and 90. Standard therapy – 325 mg/day of Aspirin for one week followed by 80 mg/day for the rest of the study period, 40 mg/day of atorvastatin, speech therapy, swallowing therapy, and physiotherapy as needed, various preventative measures against blockages developing in the deep veins of the legs or arms, and the management of any ongoing health conditions such as diabetes – was administered to all patients. Efficacy was determined with respect to a 50% reduction in overall disability, motor impairment, language impairment, and death after 30 days and 90 days of treatment.

In total, 144 patients were enrolled in the study. Of the 15 who died during the treatment period, four were in the citalopram group and 11 were in the placebo group. An additional ten in the citalopram group and 11 in the placebo group withdrew from the study. A total of 123 patients, of which 62 were on citalopram and 61 on placebo, were therefore analyzed. The average age of patients was 66.4 years. The average NIHSS score – where 1-4 represents a minor stroke, 5-15 a moderate stroke, 16-20 a moderate-to-severe stroke, and 21-24 a severe stroke – at the start of the study was 10.60. Twenty-three patients in the citalopram group had severe stroke-related disability compared to 34 in the placebo group; 21 had moderate-to-severe disability compared to 10 in the placebo group; 18 had moderate disability compared to 16 in the placebo group; and 0 had minor-to-no disability compared to 1 in the placebo group. Overall, 79% of citalopram patients had a reduction in NIHSS score of at least 50% by the end of the study, compared to 54% of placebo patients. Reductions in arm and leg motor impairments and speech and language processing impairments were more pronounced in the citalopram group than in the placebo group, both at 30 days and at 90 days. After 30 days of treatment, 34 (57%) in the citalopram group and 17 (32.1%) in the placebo group had minor-to-no stroke-related disability, and 55 (94.8%) and 22 (43.1%) after 90 days.

Coronary diseases were the most common cause of death (two citalopram patients, six placebo patients), followed by bleeding within the brain (one citalopram patient, two placebo patients), and aspiration pneumonia (one citalopram patient, two placebo patients). There was one fatal case of sepsis in the placebo group. A recurrence of ischemic stroke was observed in two citalopram patients and one placebo patient. The most common adverse reactions in the citalopram group were drowsiness and sexual dysfunction.

Overall, the study findings suggest citalopram improves acute ischemic stroke outcome at both 30 and 90 days of treatment. Improvements were seen with regard to overall impairment, motor function in the arms and legs, and speech and language processing. As an improvement in the latter four areas was assessed based on a 5-point scale, future studies may benefit from a more in-depth analysis in these areas and more comprehensive testing, particularly regarding verbal impairments. The similarly low rates of death and adverse conditions in citalopram and placebo patients suggest the drug is safe and tolerable in acute ischemic stroke patients.

Written by Raishard Haynes, MBS

Reference:

Oskouie, D.S. et al. (2017). Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial. Neurorehabil Neural Repair. DOI: 10.1177/1545968317704902 journals.sagepub.com/home/nnr

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