Study on Citalopram for Ischemic Stroke Treatment

Understanding Ischemic Stroke

Ischemic stroke occurs when blood vessels in the brain become blocked, depriving specific areas of oxygen and nutrients. Currently, anti-clotting medications are the sole treatments that have proven effective in reducing the likelihood and severity of post-stroke disability. However, their limited effectiveness and availability prompt the need for alternative treatment options.

Citalopram as a Potential Treatment

Recent investigations have highlighted the potential for selective serotonin reuptake inhibitors (SSRIs) like citalopram, usually prescribed for depression, to alleviate motor impairments in patients recovering from ischemic stroke. Further studies are essential to validate these findings and assess citalopram’s effectiveness in addressing motor impairments associated with ischemic stroke.

Research Methodology

A study published in *Neurorehabilitation and Neural Repair* explored the safety and efficacy of citalopram specifically for acute ischemic stroke. Conducted over three months, the research involved adult patients aged 95 and younger who were recruited within seven days of symptom onset. Participants with severe ischemic stroke who were also depressed, had taken other antidepressants or antipsychotics within the last month, had a history of stroke-related disability, were on anti-clotting therapy, or had other disabling conditions were excluded from the trial.

Study Procedures

Upon hospital admission, all participants underwent computed tomography (CT) scans of the brain, and magnetic resonance imaging (MRI) was performed within the first three days of their stay. Participants were randomly assigned to receive either 20 mg of citalopram or a placebo daily. Blood samples were collected on the first day of the study. Disability assessments were conducted at 30 and 90 days post-treatment.

All patients received standard care, including 325 mg/day of Aspirin for one week, followed by 80 mg/day for the remaining study duration, 40 mg/day of atorvastatin, speech therapy, swallowing therapy, physiotherapy as needed, and measures to prevent deep vein blockages, along with management of ongoing health conditions such as diabetes. Efficacy was assessed based on a 50% reduction in overall disability, motor impairments, language skills, and mortality rates at 30 and 90 days.

Study Results

A total of 144 patients were enrolled in the study. During the treatment period, 15 patients died, with four from the citalopram group and eleven from the placebo group. Additionally, ten patients in the citalopram group and eleven in the placebo group withdrew from the study, resulting in a final analysis of 123 patients—62 receiving citalopram and 61 receiving a placebo. The participants had an average age of 66.4 years and an initial NIHSS score of 10.60, indicating moderate stroke severity.

Disability Outcomes

Among the participants, 23 in the citalopram group experienced severe stroke-related disabilities, compared to 34 in the placebo group. The analysis revealed that 79% of patients on citalopram achieved at least a 50% reduction in their NIHSS scores by the end of the study, in contrast to 54% of those on placebo. Improvements in motor function of the arms and legs, as well as in speech and language processing, were notably greater in the citalopram group at both the 30 and 90-day marks.

After 30 days, 34 patients (57%) in the citalopram group reported minor-to-no stroke-related disabilities, compared to 17 (32.1%) from the placebo group. These figures increased significantly after 90 days, with 55 (94.8%) in the citalopram group versus 22 (43.1%) in the placebo group.

Adverse Events and Safety

The most common causes of death included coronary diseases (two in the citalopram group and six in the placebo group), bleeding in the brain (one citalopram patient and two placebo patients), and aspiration pneumonia (one citalopram patient and two placebo patients). Additionally, there was one fatal case of sepsis in the placebo group. A recurrence of ischemic stroke was reported in two patients from the citalopram group and one from the placebo group. The citalopram group experienced common adverse reactions, including drowsiness and sexual dysfunction.

Conclusion

The findings of this study suggest that citalopram may enhance recovery outcomes for patients suffering from acute ischemic stroke at both 30 and 90 days post-treatment. Improvements were noted in overall impairment, motor function, and speech and language processing. Given the positive outcomes and similar rates of death and adverse events between the citalopram and placebo groups, the study indicates that citalopram is a safe and tolerable option for patients with acute ischemic stroke. Future research should aim for a more in-depth analysis of these improvements, especially regarding verbal impairments.

Written by Raishard Haynes, MBS
Reference: Oskouie, D.S. et al. (2017). Efficacy of Citalopram on Acute Ischemic Stroke Outcome: A Randomized Clinical Trial. *Neurorehabil Neural Repair*. DOI: 10.1177/1545968317704902 journals.sagepub.com/home/nnr