A Cochrane review [Abstract] 1 included 63 studies with a total of 9168 stroke patients. Most trials recruited participants in their 60s. The mean time since stroke was from 0 to 3 months for 38 trials, 3 to 6 months in 4 trials and 6 to 9 months in 2 trials. The time was not reported for 12 trials but no trials recruited patients from 9 to 12 months after stroke. About half the trials required patients to have depression to enter the trial. The duration, drug, and dose varied between trials. Most of the trials provided data only at end of treatment and not at follow-up. A meta-analysis of 3 trials at low risk of bias found little or no effect of SSRI on either disability score: SMD −0.01 (95% CI −0.09 to 0.06; 2 studies, n=2829) or independence: RR 1.00 (95% CI 0.91 to 1.09; 3 studies, n=3249). SSRIs reduced the average depression score (SMD 0.11 lower, 0.19 lower to 0.04 lower; 2 trials, n=2861), but there was a higher number of gastrointestinal side effects among the SSRI group compared to placebo (RR 2.19, 95% CI 1.00 to 4.76; 2 studies, n=148). For seizures there was no evidence of a substantial difference. When all trials are included in a sensitivity analysis, irrespective of risk of bias, SSRIs appeared to reduce disability scores but not dependence. One large trial (FOCUS) dominated the results.
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients and interventions).
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