Abstract
BACKGROUND: Poststroke dysphagia is associated with poor functional recovery and psychological consequences, including depression and fatigue, which may impede successful rehabilitation. Here, we investigate whether antidepressants may improve dysphagia recovery after acute ischemic stroke. METHODS: In this prospective cohort study, patients with acute ischemic stroke (aged ≥18 years; consecutively enrolled in the STROKE-CARD trial (Post-Stroke Disease Management) 2014 to 2019 and registry 2020 to 2023 in Innsbruck, Austria) were examined for poststroke dysphagia (by standardized clinical and instrumental examinations) and antidepressant intake at hospital admission, discharge, and inpatient 3-month follow-up. The outcome was full oral diet resumption 3 months poststroke. Associations were analyzed using multivariable logistic regression and are presented as adjusted odds ratios, adjusting for age, sex, stroke severity, dysphagia severity, depression severity, stroke localization, thrombolysis, cognitive impairment, functional disability before stroke and at hospital discharge, and study type. RESULTS: Poststroke dysphagia affected 380 (18.6%) of the total cohort of 2046 patients at hospital admission (mean age, 72.7±14.1 years; 37.8% women) and persisted in 290 (14.7%) and 95 (4.6%) patients until hospital discharge and 3-month follow-up, respectively. Among the 290 patients with persistent dysphagia at discharge included in the outcome analysis, antidepressant intake increased from 4.8% before stroke to 27.6% at hospital discharge and 49.0% at 3 months (P<0.001). A total of 195 (67.2%) of 290 patients with persistent dysphagia regained full oral diet by 3 months, with significantly higher recovery rates in those who were discharged on antidepressants (78.8% versus 62.9%; P=0.010). Antidepressant intake at hospital discharge was independently associated with improved dysphagia recovery at 3 months (adjusted odds ratio, 2.98 [95% CI, 1.51-5.87]; P=0.002). CONCLUSIONS: Antidepressant intake was associated with better dysphagia recovery after acute ischemic stroke. As these findings are observational, randomized trials are required to clarify whether antidepressants can support dysphagia rehabilitation.