Timing of antidepressant use influences long term functional status in New Zealand stroke patients: A retrospective population level study

This retrospective analysis explored the relationship between the timing of antidepressant use and long-term functional status after stroke.

We used linked health administrative data from a cohort of adult stroke patients in New Zealand. Demographics and prescription information were obtained from the National Minimum Dataset and Pharmaceutical Collection. Activities of Daily Living (ADL) scores for the same patients were obtained from the International Resident Assessment Instrument (InterRAI™). Beta regression investigated any relationship between antidepressant exposure and functional status.

Of 3509 patients with an ischaemic stroke, 31% used antidepressants in the three months before or after stroke. The adjusted odds ratio (OR) for exposure before and after stroke was 0.92 (95% confidence interval [CI]: 0.83-1.01) and 1.19 (95% CI: 1.06-1.31) for post-stroke exposure. Tricyclic antidepressant (TCA) or venlafaxine use after stroke was associated with greater odds of a lower ADL score compared to selective serotonin reuptake inhibitors (SSRI).

Patients prescribed antidepressants after stroke had increased odds of higher ADL scores indicating poorer long-term functional status than those who used them before and after stroke or not at all. TCAs and venlafaxine appeared less detrimental to long term function than SSRIs and may be better options for managing post stroke depression.

Key take-home messages

Timing of antidepressant use impacts stroke recovery – Patients who started antidepressants only after stroke had poorer long-term functional outcomes compared to those who used them before and after stroke or not at all.

Choice of antidepressant matters – Tricyclic antidepressants (TCAs) and venlafaxine were associated with better functional outcomes than SSRIs, suggesting that SSRIs may not be the best option for post-stroke depression management.

Poorer functional outcomes were not due to stroke severity – No difference in hospital length of stay between groups suggests that the negative impact of post-stroke antidepressant use on function is not simply due to more severe strokes.

Future research should guide prescribing decisions – More studies are needed to understand whether antidepressants directly influence recovery or if patient characteristics drive these outcomes, helping to refine treatment strategies for optimising both mental health and functional recovery in stroke survivors.