Certain Medications May Boost Stroke Recovery | News | Loyola Medicine
Friday, October 23, 2015

Antidepressants and Alzheimer’s disease drugs may boost recovery in stroke patients, Loyola researchers report

Drugs used to treat depression and Alzheimer’s disease also can help patients recover from strokes

MAYWOOD, Ill. – Evidence is mounting that drugs used to treat depression and Alzheimer’s disease also can help patients recover from strokes.

But there are conflicting findings from studies of these and other drugs given to recovering stroke patients. Large, well-designed studies are needed before any drug can be recommended routinely for stroke recovery, according to a paper in the journal Drugs and Aging by neurologists Xabier Beristain, MD, and Esteban Golombievski, MD, of Loyola University Medical Center and Loyola University Chicago Stritch School of Medicine.

“These medications have not yet been clearly proven to be of benefit to patients recovering from strokes,” Dr. Beristain said.

Speech and physical therapies traditionally have been the mainstays of stroke rehabilitation programs. But more than half of stroke survivors are left with some neurological impairment. “The limitations of these rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery,” Drs. Beristain and Golombievski write.

So far, the most promising drug treatments are antidepressants to improve motor recovery and Alzheimer’s disease drugs to boost recovery from aphasia (impaired ability to speak, write and understand verbal and written language).

About one in three stroke patients suffers depression, which can limit a patient’s ability to participate in rehabilitation. There is mounting evidence that the class of antidepressants known as selective serotonin reuptake inhibitors, or SSRIs (such as Prozac, Paxil and Celexa), may enhance neurological recovery beyond their effect on mood. Another type of antidepressant, norepinephrine reuptake inhibitor (NRI) also has shown benefit.

An analysis of 56 clinical trials of SSRIs found the drugs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke. However, these findings should be taken with caution because the studies have different designs. Several additional clinical trials now underway are evaluating the use of antidepressants to enhance stroke recovery.

There is growing evidence that Alzheimer’s disease drugs called acetylcholinesterase inhibitors (including Aricept, Exelon and Razadyne) can improve aphasia in stroke patients. A second type of Alzheimer’s medication under study is memantine (Namenda). When used in combination with therapy, memantine has shown language benefits lasting at least one year when compared with a placebo. But clinical evidence of memantine for stroke recovery remains limited.

So far, most studies of these and other drugs used for stroke recovery have been small, employing different methodologies and time windows between the stroke and the clinical intervention.

“We need well-designed, large clinical trials with enough power to establish the usefulness of medications as adjuvants to rehabilitation before we can routinely recommend the use of these agents to enhance neurological recovery after stroke,” Drs. Beristain and Golombievski write.

Dr. Beristain is an associate professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Dr. Golombievski is a former neurology fellow at Loyola.

The paper is titled “Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.