Efficacy of Fluoxetine for Post-Ischemic Stroke Depression in Tanzania

• Published in: Journal of stroke and cerebrovascular diseases Vol. 31; no. 1; p. 106181
• Main Authors: Rice, Dylan R., Okeng'o, Kigocha, Massawe, Emmanuel, Ismail, Seif, Mworia, Notburga A., Chiwanga, Faraja, Kapina, Boniface, Wasserman, Michael, Mateen, Farrah J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-01-2022
• Subjects: Adult; Africa; Aged; Antidepressive Agents, Second-Generation - therapeutic use; Depression; Depression - drug therapy; Depression - epidemiology; Female; Fluoxetine; Fluoxetine - therapeutic use; Humans; Ischemic Stroke - complications; Male; Middle Aged; Stroke; Tanzania - epidemiology; Treatment; Treatment Outcome; Tanzania; Depression; Stroke; Treatment; Fluoxetine; Africa
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106181

Post-stroke fluoxetine trials are primarily conducted in high-income countries. We characterize post-ischemic stroke depression in fluoxetine-treated and -untreated study participants in urban Tanzania.
Adults (>18 years old) within 14 days of CT-confirmed acute ischemic stroke onset were enrolled at Muhimbili National Hospital, Tanzania. The fluoxetine-treated group took 20mg fluoxetine daily for 90 days in a phase II trial and were compared to fluoxetine-untreated historical controls. The primary outcome was depression at 90 days, measured by the Patient Health Questionnaire-9 (PHQ-9). PHQ-9 scores were compared between fluoxetine-treated and -untreated groups. A score >=9 points was considered to reflect depression. A multivariable linear regression model assessed associations with post-stroke PHQ-9 scores.
Of the fluoxetine-treated (n=27) and -untreated (n=32) participants, the average age was 56.8 years old (39% women, 100% Black/African). The average presentation NIHSS score was 12.1 points and modified Rankin Scale (mRS) score was 3.5. The average mRS score at 90-day follow-up was 2.3. There was no significant difference between 90-day PHQ-9 scores in the fluoxetine-treated (mean=4.1 points, standard deviation=3.2; 11% depression) and untreated (mean=4.4, standard deviation=4.8; 19% depression) groups, p=.69. In the multivariable analysis, older age (β=0.08, p=.03) and higher NIHSS score (β=0.15, p=.04), but neither fluoxetine (β=0.57, p=.59) nor sex (β=-0.51, p=.63), were significantly associated with more depressive symptoms.
Our findings parallel results from trials from higher income settings that fluoxetine does not significantly improve post-ischemic stroke depression, although our sample size was small. More work is needed to depict the longitudinal nature and treatment of post-stroke depression in Sub-Saharan Africa.