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General Medicine
Routine fluoxetine in stroke
  1. Carl Heneghan1,
  2. Kamal R Mahtani2
  1. 1 Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
  2. 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Professor Carl Heneghan, Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK; carl.heneghan{at}

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A recent UK trial addressed whether routine use of fluoxetine in patients who had a stroke improved motor recovery at 6 months.

EBM Verdict

EBM Verdict on: Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial. FOCUS Trial Collaboration. Lancet 2019;393:265–74. doi: 10.1016/S0140-6736(18)32823-X.

  • Fluoxetine 20 mg after an acute stroke does not improve functional outcomes. Although it appears to have some beneficial impact on the occurrence of depression (NNT 27), treatment decisions need to be balanced against the potential increase in bone fractures among the treated group (NNH 68).

Stroke is a debilitating life-changing event that causes considerable mortality and morbidity. An ageing and growing population are thought to be some of the factors contributing to a rise in the incidence. However, improved management of acute stroke and better treatment of modifiable risk factors have led to an increase in the number of stroke survivors.

Depression is a frequent complication following a stroke, occurring in up to 50% of patients.1 A previous …

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  • Contributors CH wrote the first draft, and KRM contributed to the redrafting.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the National Health Service (NHS), the National Institute for Health Research (NIHR) or the Department of Health and Social Care.

  • Competing interests CH and KRM are supported by the NIHR School for Primary Care Research Evidence Synthesis Working group (NIHR SPCR ESWG project 390). CH is also supported by the NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, an NIHR senior investigator and editor in chief of BMJ Evidence-Based Medicine (BMJ EBM). KRM is an associate editor of BMJ EBM.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Patient consent for publication Not required.