Anti-inflammatory response and psychiatric correlates of COVID-19 infection

[Daniel E.]

Luvox, a SSRI for OCD, may help prevent COVID-19 from getting worse due to its anti-inflammatory effects. The first results of a national trial should available next month. Based on small, preliminary trial, the director of the NIH says that doctors may want to consider Luvox as a "tool in their tool chest."

Finding a possible early treatment for COVID-19 in a 40-year-old antidepressant

Sharyn Alfonsi reports on the unusual path fluvoxamine, a drug commonly used to treat obsessive-compulsive disorder, has had to becoming an early treatment candidate for COVID-19.

www.cbsnews.com

Dr. Reiersen remembered a study published a year earlier by these researchers at the University of Virginia on mice. They found fluvoxamine stopped sepsis. Sepsis is a runaway immune response in which inflammation gets out of control, damages organs and can be deadly. It's believed a similar phenomenon occurs in COVID patients...

Sharyn Alfonsi: You thought, this is something that might be able to stop inflammation from going into overdrive?

Dr. Angela Reiersen: Right. Either stop the inflammation from going into overdrive or shut it down once it had started to prevent our own bodies from destroying ourselves basically.

Similarly with other SSRIs like Prozac:

Can a common antidepressant help in the fight against COVID-19?

Two psychiatrists had a theory, and with support from a Silicon Valley philanthropist they've published some encouraging findings.

www.latimes.com

“My hypothesis in early March was that … antidepressants including fluvoxamine and fluoxetine could work for COVID because of their anti-inflammatory and potentially antiviral properties,” said Dr. Nicolas Hoertel, associate professor of psychiatry at Paris University and a psychiatrist at a hospital just outside the city.

“I also noticed at this time that almost no patients with psychiatric disorders hospitalized in my unit had symptomatic COVID, whereas many caregivers had COVID symptoms in the unit,” Hoertel said.

 

[Daniel E.]

How a cheap antidepressant emerged as a promising Covid-19 treatment

Most Covid-19 drug treatments that have been included in trials haven’t panned out. A large new study suggests fluvoxamine might be different.

www.vox.com

Aug 26, 2021

...Patients given fluvoxamine [Luvox] within a few days after testing positive for Covid-19 were 31 percent less likely to end up hospitalized and similarly less likely to end up on a ventilator. (Death from Covid-19 is rare enough that the study has wide error bars when it comes to how much fluvoxamine reduces death, meaning it’s much harder to draw conclusions.) It’s a much larger effect than any that has been found for an outpatient Covid-19 treatment so far.

“This is a huge finding,” study co-author Ed Mills, a professor of health sciences at McMaster University, told me. “The game changers are things we already had in the cupboards.”

What makes this result potentially such a big deal is that fluvoxamine is inexpensive and has already been FDA approved for obsessive-compulsive disorder (OCD), so any doctor can prescribe it for Covid-19 using their clinical judgment (what’s called “off-label” prescribing). It’s a pill, which means it doesn’t need to be administered in a hospital or by a medical professional.

To be clear, these results have just been released, and clinicians around the world will want to take a close look at them as they decide whether or not to prescribe fluvoxamine. Future research could also moderate this exciting result...

[Fluvoxamine] binds to a receptor in cells that regulates cellular stress response and the production of cytokines, proteins that tell the body something is wrong and cause inflammation. Researchers at the University of Virginia found that fluvoxamine reduced inflammation in animals. Reiersen wondered if that was why it worked well for her patients...

 

[David Baxter PhD]

This report referenced by stillKaty09 above is from a case study of just 3 patients. The conclusion of the authors, quoted above, should not be generalized to the general population and any link to COVID-19 should be viewed as purely correlative (coincidental) in the absence of confirmatory evidence from larger controlled studies.

Small Number of Covid Patients Develop Severe Psychotic Symptoms (Published 2020)

Most had no history of mental illness and became psychotic weeks after contracting the virus. Cases are expected to remain rare but are being reported worldwide.

www.nytimes.com

On the other hand, this report in the New York times indicates

Beyond individual reports, a British study of neurological or psychiatric complications in 153 patients hospitalized with Covid-19 found that 10 people had “new-onset psychosis.” Another study identified 10 such patients in one hospital in Spain. And in Covid-related social media groups, medical professionals discuss seeing patients with similar symptoms in the Midwest, Great Plains and elsewhere.

Again, given the number of total COVID-19 infections world-wide, this should be considered an extremely rare result which is still lacking a causal link to the virus itself. For example, the psychotic symptoms may be triggered by the rather extreme stress of the patients learning they were infected by the virus at a time when the vaccines were just being developed and were not yet readily available to most individuals (both the report published in Psychosomatics and the report in The New York Times are from 2020).