Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy.
OBJECTIVE
In animals, drugs that increase brain amine concentrations influence the rate and degree of recovery from cortical lesions. It is therefore conceivable that antidepressants may influence outcome after ischemic brain injury in humans. We evaluated the effects of the norepinephrine reuptake blocker maprotiline and the serotonin reuptake blocker fluoxetine on the motor/functional capacities of poststroke patients undergoing physical therapy.


METHODS
Fifty-two severely disabled hemiplegic subjects were randomly assigned to three treatment groups; during 3 months of physical therapy, patients were treated with placebo, maprotiline (150 mg/d), or fluoxetine (20 mg/d). Before and at the end of the observation period, we assessed activities of daily living by the Barthel Index, degree of neurological deficit by a neurological scale for hemiplegic subjects, and depressive symptomatology by the Hamilton Depression Rating Scale.


RESULTS
The diverse treatments ameliorated walking and activities of daily living capacities to different extents. The greatest improvements were observed in the fluoxetine-treated group and the lowest in the maprotiline-treated group. Furthermore, fluoxetine yielded a significantly larger number of patients with good recovery compared with maprotiline or placebo. These effects of the drugs were not related to their efficacy in treating depressive symptoms.


CONCLUSIONS
Fluoxetine may facilitate or, alternatively, maprotiline may hinder recovery in poststroke patients undergoing rehabilitation. The effects of fluoxetine as an adjunct to physical therapy warrant further investigation, since treatment with fluoxetine may result in a better functional outcome from stroke than physical therapy alone.
Dam
M
M
Department of Neurological and Vision Sciences, University of Verona, Italy.
Tonin
P
P
De Boni
A
A
Pizzolato
G
G
Casson
S
S
Ermani
M
M
Freo
U
U
Piron
L
L
Battistin
L
L
D000203:Activities of Daily Living; D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage / Q000627:therapeutic use*; D002545:Brain Ischemia / Q000150:complications / Q000534:rehabilitation; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000534:rehabilitation; D003863:Depression / Q000523:psychology; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage / Q000627:therapeutic use*; D006429:Hemiplegia / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008376:Maprotiline / Q000008:administration & dosage / Q000627:therapeutic use*; D009460:Neurologic Examination; D026741:Physical Therapy Modalities; D010919:Placebos; D011597:Psychomotor Performance / Q000187:drug effects; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D016138:Walking
D018759:Adrenergic Uptake Inhibitors; D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine; D008376:Maprotiline; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors