Selective Serotonin Reuptake Inhibitors May Be Helpful in Most Patients With Stroke

The clinical presentation of this patient with no past history of stroke shows a moderate to severe neurological deficit associating aphasia and hemiparesis (National Institutes of Health Stroke Scale, 14). Fugl-Meyer Motor Scale score of 35 indicates that some movements with his right side are possible but that he is probably bedridden and unable to walk. One can find several arguments to propose starting this patient on a selective serotonin reuptake inhibitor (SSRI) such as fluoxetine. Small clinical trials in patients with ischemic stroke have shown that SSRIs can induce active changes in cortical excitability.1,2 Recently, the Fluoxetine for motor recovery after acute ischemic stroke (FLAME) trial3 demonstrated a positive action of a 3-month treatment with fluoxetine (20mg daily) against placebo in a selected population of 113 nondepressed patients with ischemic stroke. In this study, patients had severe motor deficit (mean Fugl-Meyer Motor Scale 13.4 and 17.1 in the placebo and fluoxetine groups, respectively; mean National Institutes of Health Stroke Scale 13.1 and 12.8 in the placebo and fluoxetine groups, respectively) and were treated within the first days after the stroke onset. Fugl-Meyer Motor Scale improvement at Day 90 …