Background: Neuroprotective and neurorestorative effects have been postulated for
selective serotonin-reuptake inhibitors (SSRI). We hypothesized that
sertraline, which is characterized by less severe adverse effects and more stable pharmacokinetics than classic SSRI, is associated with improved functional recovery in
acute ischemic stroke patients with motor deficits. Methods: Prospective observational study of consecutive
acute ischemic stroke patients who received
sertraline for clinically suspected post-
stroke depression (PSD) or at high risk for PSD. Eligibility comprised acute motor deficit caused by
ischemic stroke (≥2 points on NIHSS motor items) and functional independence pre-
stroke (mRS ≤1). Decision to initiate treatment with SSRI during
hospital stay was at the discretion of the treating
stroke physician. Patients not receiving
sertraline served as control group. Favorable functional recovery defined as mRS ≤2 was prospectively assessed at 3 months. Multivariable logistic regression analysis was used to explore the effects of
sertraline on 3-months functional recovery. Secondary outcomes were frequency of any and incident PSD (defined by BDI ≥10) at 3 months. Results: During the study period (03/2017-12/2018), 114 patients were assigned to
sertraline (n = 72, 62.6%) or control group (n = 42, 37.4%). At study entry, patients in
sertraline group were more severely neurologically affected than patients in the control group (NIHSS: 8 [IQR, 5-11] vs. 5 [IQR, 4-7]; p = 0.002). Also, motor NIHSS scores were more pronounced in
sertraline than in control group (4 [IQR 2-7] vs. 2 [IQR 2-4], p = 0.001). After adjusting for age and baseline NIHSS, multivariable regression analysis revealed a significant association between
sertraline intake and favorable functional outcome at 3 months (OR 3.10, 95% CI 1.02-9.41; p = 0.045). There was no difference between both groups regarding the frequency of any depression at 3 months (26/53 [49.1%] vs. 14/28 [50.0%] patients, p = 0.643, BDI ≥10). However, fewer incident depressions were observed in
sertraline group patients compared to patients in control group (0/53 [0%] vs. 5/28 [17.9%] patients, p = 0.004). Conclusions: In this non-randomized comparison, early treatment with
sertraline tended to favor functional recovery in patients with
acute ischemic stroke. While exploratory in nature, this hypothesis needs further investigation in a clinical trial.