Antidepressants may aid stroke recovery

A single dose of the antidepressant fluoxetine (Prozac, Sarafem) improved scores on movement tests and activated brain areas responsible for movement in patients who had recently suffered strokes, according to a study published in the December 2001 Annals of Neurology, the research journal of the American Neurological Association. According to the French research group that conducted the study, the results suggest that the drug can directly speed functional recovery in stroke patients.

"These data support the principle that recovery of function from stroke can be influenced by pharmacological manipulation in humans," said John A. Detre, M.D., a neurologist at the University of Pennsylvania, who wrote an editorial accompanying the article.

The study stems from earlier observations suggesting that antidepressants enhance recovery after stroke. Physicians have wondered whether the drugs were directly affecting the recovery of brain areas that control movement, or whether patients simply put more effort into physical rehabilitation programs because of the antidepressant properties of the drugs.

The researchers in the current study investigated 8 patients two to three weeks after their strokes. They were careful to select patients who had experienced limited strokes that affected only their movement, not their ability to understand or follow instructions.

The patients were divided into two groups, one of which received the drug during the first tests 14 days after the stroke, while the others received a placebo (sugar pill). One week later, the test was repeated with those patients who had received the placebo now getting the drug, and vice-versa.

The movement testing assessed a patient's performance on simple tasks such as rapid finger tapping or grip strengthening. The brain study was conducted with functional magnetic resonance imaging (fMRI) during the performance of simple movements.

The single dose of fluoxetine, administered a few hours earlier, was enough to significantly improve speed and strength on the finger tapping and grip tests, compared with the placebo. This improvement correlated with a distinct fMRI activation of certain areas of the brain known to be involved in directing movement.

The researchers also noted that the drug's efficacy depended on the patient practicing the test several times, which supports the hypothesis that the most effective way to apply such drugs would be to combine them with physical therapy.

"Because patient selection, imaging and data analysis were carefully carried out, the results are highly believable," said Detre. "However, since the study used only a single dose of drug, the results do not have immediate implications for long?term management of patients recovering from stroke. "

Since fluoxetine's antidepressant qualities do not take effect after a single dose, the authors say this study strongly supports the idea that the drug directly enhances the performance of brain cells that direct movement. However, they acknowledge that fluoxetine may have another indirect effect, in simply improving the patient's attention to the tasks involved. This possibility will be explored in further experiments.

Before fluoxetine and similar drugs can be prescribed for motor recovery following a stroke, said author Isabelle Loubinoux, Ph.D., of the French National Institute of Health and Medical Research in Toulouse, "We must confirm these results with long-term, chronic treatment in a large number of patients."