Podcast: Selective serotonin reuptake inhibitors for stroke recovery

Stroke is a major cause of death and disability across the world, with many reviews from the Cochrane Stroke Group providing evidence on the effects of treatments and rehabilitation interventions. In November 2019, the Group published their update of their review of selective serotonin reuptake inhibitors and we asked lead author, Gillian Mead from the University of Edinburgh in Scotland, to tell us more.Stroke is a common cause of disability in the community. Although there have been major advances in the care of stroke patients over the last few years, many survivors are still left with physical disability, such as weakness down one side of the body, called hemiparesis, difficulty speaking, low mood, anxiety, fatigue, and memory and thinking problems. Therefore, we need better treatments to address stroke disability.One possibility is the group of drugs called selective serotonin reuptake inhibitors (or SSRI for short). These have been used for many years to treat mood disorders in the general population and also after stroke. In 2011, a French trial showed that one of the SSRI, fluoxetine, improved recovery of arm weakness if given early after stroke, in people without mood problems.   We then performed a Cochrane review of all trials of SSRI given after stroke and found that SSRIs did seem to reduce disability. However, we could not be confident that the results were reliable, because many of the studies were small and had multiple sources of bias. On the positive si...
Source: Cochrane News and Events - Category: Information Technology Authors: Source Type: news

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Conclusions: Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services.IMPLICATIONS FOR REHABILITATIONThe stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clin...
Source: Disability and Rehabilitation - Category: Rehabilitation Authors: Tags: Disabil Rehabil Source Type: research
AbstractTo describe sexual functioning/satisfaction and relational satisfaction of patients with stroke who received sexual counselling during their rehabilitation 1 –5 years thereafter. All adult patients with stroke admitted to one Dutch Rehabilitation Centre between January 2010 and January 2014 with at least two consultations with a sexologist were invited to participate in this cross-sectional survey study. Patients were asked to complete a questionnaire on sexual functioning, relational satisfaction (Maudsley Marital Questionnaire, 0–80; low–high dissatisfaction), health-related quality of life...
Source: Sexuality and Disability - Category: Disability Source Type: research
Abstract Stroke remains a leading cause of disability in the United States. Despite recent advances, interventions to reduce damage and enhance recovery after stroke are lacking. P2X4R, a receptor for adenosine triphosphate (ATP), regulates activation of myeloid immune cells (infiltrating monocytes/macrophages and brain-resident microglia) after stroke injury. However, over-stimulation of P2X4Rs due to excessive ATP release from dying or damaged neuronal cells can contribute to ischemic injury. Therefore, we pharmacologically inhibited P2X4R to limit the over-stimulated myeloid cell immune response and improve bot...
Source: Experimental Neurology - Category: Neurology Authors: Tags: Exp Neurol Source Type: research
CONCLUSIONS: Social stigmas related to depression and anxiety may lead to the underreporting of FMD. Chronic disease management programs in Illinois should consider integrating mental health services. PMID: 32133865 [PubMed - as supplied by publisher]
Source: American Journal of Health Promotion : AJHP - Category: International Medicine & Public Health Authors: Tags: Am J Health Promot Source Type: research
Authors: Pálsdóttir AM, Stigmar K, Norrving B, Petersson IF, Åström M, Pessah-Rasmussen H Abstract OBJECTIVE: To determine whether nature-based rehabilitation, as an add-on to standard care, has a long-term influence on post-stroke fatigue, perceived value of everyday occupations, disability, health-related quality of life, anxiety, and depression at follow-up 8 and 14 months after randomization. DESIGN: Single-blinded, 2-armed, randomized controlled trial. METHODS: Stroke survivors, identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke>...
Source: Journal of Rehabilitation Medicine - Category: Rehabilitation Tags: J Rehabil Med Source Type: research
CONCLUSION: Given the abrupt and significant life-changing nature of stroke, it is often necessary to manage a diverse array of psychological issues that often cannot be simply managed via psychotropic medications. Moreover, an understanding of the patients' emotional adjustment and issues can help them maximize their rehabilitation, recovery, and community integration. For the cases discussed, psychology consultations were central in helping optimize their rehabilitation and functional outcomes. PMID: 32083601 [PubMed - as supplied by publisher]
Source: NeuroRehabilitation - Category: Rehabilitation Tags: NeuroRehabilitation Source Type: research
Authors: Pálsdóttir AM, Stigmar K, Norrving B, Petersson IF, Åström M, Pessah-Rasmussen H Abstract OBJECTIVE: To determine whether nature-based rehabilitation, as an add-on to standard care, has a long-term influence on post-stroke fatigue, perceived value of everyday occupations, disability, health-related quality of life, anxiety, and depression at follow-up 8 and 14 months after randomization. DESIGN: Single-blinded, 2-armed, randomized controlled trial. METHODS: Stroke survivors, identified through routine 3-month follow-up visit (sub-acute) or medical records (chronic stroke>...
Source: Journal of Rehabilitation Medicine - Category: Rehabilitation Tags: J Rehabil Med Source Type: research
Conclusions: A structured and targeted caregiver intervention is urgently needed to relieve caregivers' burden and related psychological comorbidities in an Indian setup.
Source: Annals of Indian Academy of Neurology - Category: Neurology Authors: Source Type: research
The dangers of alcohol begin at the first sip of the first drink. Although most responsible drinking habits shouldn’t be cause for major concern, everyone who drinks runs the risk of encountering the negative effects of alcohol. The Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men.  A single drink is considered as: 12 ounces of beer (5% alcohol content) 8 ounces of malt liquor (7% alcohol content) 5 ounces of wine (12% alcohol content) 1.5 ounces of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, ...
Source: Cliffside Malibu - Category: Addiction Authors: Tags: Alcohol Alcohol Rehab Information Alcoholism alcohol abuse alcohol dependence alcohol dependency alcohol detox alcohol treatment alcohol treatment center alcohol treatment facility Alcoholics Anonymous Source Type: blogs
CONCLUSIONS: We found no reliable evidence that SSRIs should be used routinely to promote recovery after stroke. Meta-analysis of the trials at low risk of bias indicate that SSRIs do not improve recovery from stroke. We identified potential improvements in disability only in the analyses which included trials at high risk of bias. A further meta-analysis of large ongoing trials will be required to determine the generalisability of these findings. PMID: 31769878 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
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