Fluoxetine in stroke (FOCUS) trial—reasons to be cheerful about antidepressants in stroke?

Despite substantial advances in prevention and treatment, stroke stubbornly remains the world’s leading cause of death and adult disability (1). Stroke and the burden of stroke are increasing globally with a particular rise in the prevalence of people living with long-term stroke related disability (2). In this context, any treatment that can prevent or reduce stroke related impairments would be of substantial public health importance. Unfortunately, the stroke therapeutic toolbox has limited options. We have a robust evidence base to support hyperacute treatments such as intravenous thrombolysis and mechanical thrombectomy and we have effective secondary prevention strategies (3-5). However, to date, all putative neuroprotective or neurorestorative therapies have failed to deliver clinically important benefits.