Introduction: Although experimental data suggest that Selective serotonin reuptake inhibitors (SSRIs) may improve motor recovery after stroke, the results from clinical studies are conflicting.
Areas covered: Six international electronic databases (Cochrane, PubMed, Embase, Web of Science, CINAHL, and PsycINFO) and four Chinese electronic databases (CBM, CNKI, WanFang Data, and VIP) were systematically searched up to April 2021. Co-primary outcomes were motor function and tolerability. Secondary outcomes included disability, neurological function, continuous depression scores, and adverse events.
Results: 25 randomized controlled trials including 4777 participants were identified. Pooled analyses found SSRIs significantly improved motor function [standardized mean differences (SMD), 0.72; 95% CI, 0.46 to 0.99], disability (SMD, 0.79; 95% CI, 0.51 to 1.06), neurological function (SMD, -0.58; 95% CI, -0.77 to -0.39) and continuous depression scores (SMD, -0.36; 95% CI, -0.70 to -0.02). SSRIs were associated with increased seizure (risk ratio, 9.00; 95% CI, 1.69 to 47.91) and gastrointestinal side effects (risk ratio, 2.26; 95% CI, 1.56 to 3.28), but similar risk of all-cause discontinuations when compared with the control group (risk ratio, 1.11; 95% CI, 0.79 to 1.56).
Expert opinion: SSRIs are effective and well-tolerated to promote motor recovery after stroke, but may increase the risk of seizures and gastrointestinal adverse effects.
Keywords: Efficacy; meta-analysis; motor recovery; selective serotonin reuptake inhibitors; stroke.