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18 September 2014

Antidepressant trialled for stroke victims

A Medical and Health Research Infrastructure Fund (MHRIF) grant will help a team of WA Health researchers pursue answers to the role a commonly prescribed anti-depressant might play in the recovery of stroke patients.

Sir Charles Gairdner Hospital consultant neurologist and Winthrop Professor of Neurology at the University of Western Australia Graeme Hankey is chief investigator of a randomised, double-blind, placebo-controlled clinical trial that will seek to determine whether fluoxetine—marketed commercially as Prozac—when given to patients within the first few days of a stroke, can reduce the severity of any resultant disability.

Professor Hankey and his colleagues hope their large-scale trial will validate the seemingly remarkable results of a small French trial conducted in 2011, in which just 57 stroke patients, given the drug within 5–10 days after stroke onset and then daily for 3 months, experienced a significant improvement in recovery of limb movement and a three-fold increase in functional recovery at 3 months after stroke compared with 56 patients allocated placebo.

But Professor Hankey says the trial was too small to provide any conclusive results and more robust research was needed to determine whether fluoxetine:

  • could assist in nerve cell regeneration and improve neuroplasticity
  • improve speech and cognitive function as well as limb movement
  • was  safe to use in elderly patients, the group most prone to strokes
  • provided sustained improvement beyond the treatment period.

Dubbed AFFINITY (Assessment oF FluoxetINe In sTroke recoverY), Professor Hankey's multi-centred trial will draw on 1600 newly affected stroke patients across Australia and New Zealand including Royal Perth, Sir Charles Gairdner, Osborne Park and Swan Districts hospitals.

Participants will receive 20mg of fluoxetine or a placebo. This will be prescribed daily for six months, commencing within two to 15 days of the stroke. The severity of the patients' disability will be assessed at the start, with their recovery monitored closely while in hospital and at follow-up checks at three, six and 12 months.

Professor Hankey said fluoxetine was a simple, affordable and widely available treatment that, if found to be effective in treating stroke patients, had the potential to improve a patient's quality of life and ease the burden on carers, the health system and wider community.

Professor Hankey said that while the rate of stroke in the community was declining, the actual number of people affected by a stroke was growing.

In Western Australia about 5000 people have a stroke every year. Of these about 15 per cent die within one month of the stroke, 25 per cent within a year and at least half will be permanently disabled and need the help of a carer. Western Australia's Chief Medical Officer Gary Geelhoed said the work of Professor Hankey and his colleagues highlighted the important research being undertaken within WA Health by WA Health researchers and clinicians.

Professor Geelhoed said Professor Hankey was one of 131 researchers to share in almost $6 million awarded under the Medical Health Research Infrastructure Fund in 2013.

The fund was established in 1997 to promote excellence in medical and health research in Western Australia by providing high-performing researchers with financial support to meet the day-to-day infrastructure costs associated with their projects.

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