By Dr. Petrus Raulino
The answer to this question is not definitive, nor should the use of antidepressants be encouraged. This class of medication should only be used if indicated by a doctor after careful evaluation.
Study on the use of antidepressants for COVID-19
That said, a study published in the journal Molecular Psychiatry showed an association between the use of antidepressants and a reduced risk of intubation or death among adult patients admitted with COVID-19.
This multicenter retrospective observational study included data on all adult COVID-19 patients admitted to any of the 39 AP-HP hospitals of the Greater University of Paris at the start of the pandemic.
Antidepressant use was defined as receiving any antidepressant during the first 48 hours of hospital admission and before the end of hospitalization, intubation or death.
Study results
Despite the study's limitations, it showed that the use of antidepressants in usual doses was associated with a substantial reduction in the risk of intubation or death in patients hospitalized with COVID-19.
Although the finding is relevant, statistical biases can occur, which is why new studies are needed. In particular, double-blind randomized controlled clinical trials are important to inform changes in medical treatments.
The association observed between the use of antidepressants and a reduced risk of intubation or death, if proven, could be explained by various mechanisms, according to the study's authors.
- Firstly, previous studies suggest that various antidepressants can inhibit the activity of acid sphingomyelinase, which can prevent the infection of epithelial cells against SARS-CoV-2.
- Secondly, several antidepressants are sigma-1 receptor agonists, which can prevent the cytokine storm seen in severe COVID-19.
- Thirdly, the use of antidepressants may be associated with reduced plasma levels of several inflammatory mediators associated with severe COVID-19, including IL-6, IL-10, TNF-? and CCL-2.
- Finally, certain antidepressants can potentially exert antiviral effects on SARS-CoV-2.
Conclusion
If the association between antidepressant use and reduced risk of intubation or death from COVID-19 is confirmed in research that determines efficacy, further studies will still be needed to determine the exact mechanisms underlying this association.
For the time being, the above findings and hypotheses are not definitive, but they do provide a stimulus for further research. We're keeping an eye on things.
References
Hoertel, N., Sánchez-Rico, M., Vernet, R., Beeker, N., Jannot, A. S., Neuraz, A., ... & Limosin, F. (2021). Association between antidepressant use and reduced risk of intubation or death in hospitalized patients with COVID-19: results from an observational study. Molecular psychiatry, 1-14.
Carpenter, A., Edwards, M. J., Hoffmann, M., Kochs, G., Gripp, B., Weigang, S., ... & Gulbins, E. (2020). Pharmacological inhibition of acid sphingomyelinase prevents uptake of SARS-CoV-2 by epithelial cells. Cell Reports Medicine, 1(8), 100142.
Lenze, E. J., Mattar, C., Zorumski, C. F., Stevens, A., Schweiger, J., Nicol, G. E., ... & Reiersen, A. M. (2020). Fluvoxamine vs placebo and clinical deterioration in outpatients with symptomatic COVID-19: a randomized clinical trial. JAMA, 324(22), 2292-2300.
Gordon, D. E., Jang, G. M., Bouhaddou, M., Xu, J., Obernier, K., White, K. M., ... & Krogan, N. J. (2020). A SARS-CoV-2 protein interaction map reveals targets for drug repurposing. Nature, 583(7816), 459-468.
Hojyo, S., Uchida, M., Tanaka, K., Hasebe, R., Tanaka, Y., Murakami, M., & Hirano, T. (2020). How COVID-19 induces cytokine storm with high mortality. Inflammation and Regeneration, 40(1), 1-7.
Köhler, C. A., Freitas, T. H., Stubbs, B., Maes, M., Solmi, M., Veronese, N., ... & Carvalho, A. F. (2018). Peripheral alterations in cytokine and chemokine levels after antidepressant drug treatment for major depressive disorder: systematic review and meta-analysis. Molecular neurobiology, 55(5), 4195-4206.
Zimniak, M., Kirschner, L., Hilpert, H., Seibel, J., & Bodem, J. (2020). The serotonin reuptake inhibitor Fluoxetine inhibits SARS-CoV-2. Biorxiv.
Gulbins, E., Palmada, M., Reichel, M., Lüth, A., Böhmer, C., Amato, D., ... & Kornhuber, J. (2013). Acid sphingomyelinase-ceramide system mediates effects of antidepressant drugs. Nature medicine, 19(7), 934-938.
