Loyola Researchers Report Antidepressants and Alzheimer's Disease Drugs May Boost Recovery in Stroke Patients
October 22, 2015Categories: Neurology & Neurosurgery
Tags: Neurology Neurosurgery
MAYWOOD, IL – 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
Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. The three-hospital system includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital, as well as convenient locations offering primary care, specialty care and immediate care services from nearly 2,000 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, the John L. Keeley, MD, Emergency Department, a Level 1 trauma center, Illinois's largest burn center, the Nancy W. Knowles Orthopaedic Institute, a certified comprehensive stroke center, transplant center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing.
Established in 1961, Gottlieb Memorial Hospital is a 247-licensed-bed community hospital in Melrose Park that includes the Judd A. Weinberg Emergency Department, the Loyola Center for Metabolic Surgery and Bariatric Care, Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center, acute rehabilitation, a transitional care center, childcare center and fitness center. Founded in 1919, MacNeal Hospital is a 374-licensed-bed teaching hospital in Berwyn with advanced medical, surgical and psychiatric services and a 68-bed behavioral health program.
For more information, visit loyolamedicine.org. You can also follow Loyola Medicine on LinkedIn, Facebook, Instagram or X (formerly known as Twitter).
About Trinity Health
Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 127,000 colleagues and more than 38,300 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 93 hospitals, 107 continuing care locations, the second largest PACE program in the country, 142 urgent care locations and many other health and well-being services. In fiscal year 2024, the Livonia, Michigan-based health system invested $1.3 billion in its communities in the form of charity care and other community benefit programs. For more information, visit us at www.trinity-health.org, or follow us on LinkedIn, Facebook, and X (formerly known as Twitter).