Strokecast

Episode 039 — The FLAME Study: How Anti-depressants (SSRI) help Stroke Recovery

'Many of us in the stroke community prescribe it anyway, off label, because the benefits are so much greater than the harm, especially in the setting of stroke. And it's not even quite off label.' -- @neuronirav #stroke #ssri… Click To Tweet


This week, Dr. Nirav Shah and I talk about antidepressants — SSRIs specifically — in Stroke Recovery. The FLAME study demonstrated the benefits to motor recovery.

SSRI stands for Selective Serotonin Re-uptake Inhibitor. Basically, the way data gets sent from one nerve cell to another is through the use of chemicals, like serotonin. The body produce serotonin and the collects it when done, taking it out of the system. An SSRI slows down the collection process — it inhibits the re-uptake. That leaves more serotonin floating around the brain.

Having more serotonin floating around the brain can help reduce, manage, or eliminate depression and other conditions. That’s why SSRIs are some of the most common anti-depressants on the market.

The FLAME study looked at how Fluoxetine (AKA Prozac) behaves in folks who recently had a stroke. Fluoxetine is an old school antidepressant and SSRI. The study appeared to show that the extra serotonin in the brain may help promote neuroplasticity and recovery of motor skills after stroke, and that’s why we’re talking about it today.

'The question becomes: do we do this as part of our regular stroke care?' -- @neuronirav #stroke #ssri #antidepressant #prozac #fuoxetine #FLAMEstudy Click To Tweet

My Experience

When I was inpatient, the doctor put me on an SSRI due to the FLAME study. She tried Prozac (AKA Fluoxetine) first. Unfortunately, it gave me an anxiety attack. On the other hand, I now know what an anxiety attack feels like. Not pleasant.

A Xanax took care of that.

We tried again the next day, this time with another SSRI called Lexapro (AKA Escitalopram). Someone explained to me that the molecule that makes up Lexapro is the mirror image of the Prozac molecule. I’d had Lexapro in the past, with no ill effects so it was worth a shot. Success! No anxiety attack this time. And that’s how an SSRI earned a spot in my daily collection of medication.

But did it help my recovery? Maybe. There’s no way to tell for sure. The data indicates that it should and there is no reason to think it didn’t help. As a side effect, I did not go into the deep depression so common among other stroke survivors.

(Post stroke depression) is probably one of the reasons many people may not have the desire to even participate actively in therapy.' -- @neuronirav #stroke #ssri #antidepressant #prozac #fuoxetine #FLAMEstudy Click To Tweet

This is a new use for SSRIs, Fluoxetine, and Escitalopram. It’s borderline off-label. Not all doctors are familiar with the idea that SSRIs promote the neuroplasticity that supports recovery of motor functions. And that’s how I ended up explaining the research to my primary care physician as he reviewed my meds with me post-hospital.

The FLAME study covered 6 months. I’m still taking the Lexapro today. When I talked to my rehab doctor about whether I should continue we concluded that since I don’t have any negative results from it, we may as well keep it up. If there’s a chance it can help, and it’s not hurting, then that sounds good to me.

Dr. Nirav H. Shah

Dr. Nirav H Shah Headshot

Dr. Nirav H. Shah is a fellowship trained neurologist and sub-specialist in cerebrovascular and stroke medicine with board certifications in t: neurology, stroke medicine, carotid neurosonology, transcranial doppler ultrasound, and neuroimaging.

He is a practicing neurohospitalist and served as the stroke medical director at Swedish Medical Center in Seattle. Academically, he is interested in emergent and critical care neurology research and is an associate editor for The Neurohospitalist, a peer-reviewed journal. He enjoys mentoring trainees and collaborating on publications and conference presentations.

Outside of clinical care Dr Shah is collaborating with experts to develop scalable technologies capable of ameliorating healthcare’s challenges. He consults with startups and investors to develop technologies and devices so that one day they are available to his patients. He has worked with companies to meet FDA regulations for approval as well as to help them understand the provider perspective of product-market fit.

Dr. Shah is also the CEO and Founder of Sentinel Healthcare. He is also a passionate traveler and photographer.

So let’s fan the FLAME of stroke recovery with Nirav.

Hack of the Week

Daily pill organizer with one door openMany stroke survivors use a day of the week pill organizer to keep track of meds. And, sometimes, the day of the week. The organizer can also make it easy to keep track of whether or not we’ve taken pills for the day.

After taking your pills, leave the door for that day open exposing the now empty chamber. That gives you and your caregiver an easy to see visual queue the deed is done.

 

Links

FLAME study Presentation http://www.my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_427770.pdf
Efficacy of Fluoxetine – a Trial in Stroke (EFFECTS) https://clinicaltrials.gov/ct2/show/NCT02683213
Predicting recovery in acute poststroke aphasia https://www.ncbi.nlm.nih.gov/pubmed/29451321
Nirav’s previous appearance http://strokecast.com/nirav
Nirav on Stem Cells and Stroke Recovery http://strokecast.com/stemcells
Nirav  on LinkedIn https://www.linkedin.com/in/nirav-h-shah/
Nirav at Swedish https://www.swedish.org/swedish-physicians/profile.aspx?name=nirav+h+shah&id=271893
Nirav on Twitter http://twitter.com/NeuroNirav
The Neurohospitalist http://journals.sagepub.com/home/nho
Nirav’s Photography www.thoughtpotential.com
Sentinel Healthcare http://www.sentinel.healthcare/

Where do we go from here?

  • Check out the links to the FLAME study and the other SSRI stroke studies above.
  • Subscribe to Strokecast for free in your favorite podcast app.
  • Use your pill box door as a reminder/calendar.
  • Don’t get best…get better.
'We've had SSRIs for depression since the 90s. Why are we only now starting to have these studies done?' The answer's probably because there's no money in it.' -- @neuronirav #stroke #ssri #antidepressant #prozac #fuoxetine… Click To Tweet

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