Retrospective Analysis of an Acute Ischemic Stroke Cohort Shows that Timing of Antidepressant Use Associated with Short-term Recovery and Functional Independence at 90-Days

Abstract

AbstractBackgroundLittle is known about how the timing of antidepressant use influences stroke outcomes. The objective of this exploratory, retrospective analysis is to examine stroke outcomes by timing of antidepressant use among patients who received stroke treatment.Methods12,590 eligible patients were treated for a primary or secondary diagnosis of ischemic stroke. Inpatient strokes and patients who were missing information on antidepressant use or stroke outcomes were excluded. The outcome variables were (1) a change in ambulation from pre-stroke to discharge; (2) a change in modified Rankin scale (mRS) from pre-stroke to discharge; and (3) a change in mRS from pre-stroke to 90-days post-discharge. The independent variable of interest was timing of antidepressant treatment. Logistic regression with generalized estimating equations was used, controlling for covariates.ResultsAt 90-days post-discharge, patients with no history of antidepressant use or with a previous history of antidepressant use were similar to patients with current antidepressant use in terms of their return to baseline functional independence. In contrast, our model predicted that a new antidepressant prescription at discharge was associated with a ∼57% decrease in the likelihood of returning to baseline functional independence at 90-days compared to patients currently using an antidepressant (AOR:0.510, CI:0.277-0.938, p=0.03). Post-hoc analyses showed females with current antidepressant use associated with a higher predicted probability of returning to baseline functional independence at 90-days compared to females with no antidepressant use. This association was not true for males. Conversely, males with a new prescription had the lowest predicted probability of returning to baseline among all groups at 90-days post-discharge.ConclusionThese results suggest that use of antidepressants was associated with stroke recovery, but the effects are moderated by sex. Further study is needed to determine if this relationship is causal and the mechanisms between timing of antidepressant treatment and outcomes.