Mental disorders, psychopharmacological treatments, and mortality in 2150 COVID‐19 Spanish inpatients

Abstract

Objective To determine how mental disorders and psychopharmacological treatments before and during COVID‐19 hospital admissions are related to mortality. Methods Subjects included in the study were all adult patients with a diagnosis of COVID‐19, confirmed clinically and by PCR, who were admitted to a tertiary university hospital in Badalona (Spain) between March 1 and November 17, 2020. Data were extracted anonymously from computerized clinical records. Results 2,150 subjects were included, 57% males, mean age 61 years. History of mental disorders was registered in 957 (45%). Throughout admission, de novo diagnosis of mood or anxiety, stress, or adjustment disorder was made in 12% of patients without previous history. Delirium was diagnosed in 10% of cases. 1011 patients (47%) received a psychotropic prescription during admission (36% benzodiazepines, 22% antidepressants, and 21% antipsychotics). Mortality rate was 17%. Delirium during admission and history of mood disorder were independently associated with higher mortality risk (hazard ratios, 1.39 and 1.52 respectively), while previous year's treatments with anxiolytics/hypnotics and antidepressants were independently associated with lower mortality risk (hazard ratios, 0.47 and 0.43, respectively). Conclusion Mental symptoms are very common in patients hospitalized for COVID‐19 infection. Detecting, diagnosing, and treating them is key to determining the prognosis of the disease and functional recovery.

Analysis of the impact of antidepressants and other medications on COVID-19 infection risk in a chronic psychiatric in-patient cohort

“…5,6 On the other hand, two large observational studies conducted in Europe (France and Spain), both demonstrated the significant, and positive association between antidepressant use and a reduced risk of intubation or death in patients admitted to hospital with COVID-19. 7,8 This data is strongly supported by the encouraging findings from clinical trials of the selective serotonin reuptake inhibitor (SSRI) fluvoxamine in the USA, in which treated patients exhibited a significantly lower likelihood of clinical deterioration, 9 or showed improved respiratory rates and significantly lower incidence of subsequent admission to hospital approximately 2 weeks after the onset of treatment. 10 It has also been postulated that some medications may alter the risk of COVID-19 infection following exposure by obstructing SARS-CoV-2 host cell entry, which occurs via the virus binding to the membrane-bound angiotensin-converting enzyme 2 (ACE2) in the nasal passages and lungs.…”

Mortality Risk Among Patients With COVID-19 Prescribed Selective Serotonin Reuptake Inhibitor Antidepressants

“…[13][14][15] In fact, an intake of functional inhibitors of acid sphingomyelinase activity medications, which inhibit the acid sphingomyelinase/ ceramide system and include fluoxetine hydrochloride and fluvoxamine maleate (among other medications), was associated with substantially reduced likelihood of intubation or death among hospitalized patients with COVID-19. 16,17 Although findings from some studies have suggested that psychiatric diagnosis, including mood and anxiety disorders, may be an independent risk factor for COVID-19 infection, 18,19 other epidemiological studies have suggested that major depression could be associated with reduced mortality in COVID-19, 20,21 possibly owing to the use of antidepressants in this population. 1,20 A recent observational study 1 showed a decreased mortality rate in hospitalized patients with COVID-19 who were prescribed antidepressants (n = 460), in particular SSRIs, but this study had limited power.…”

Cross-National Variations in COVID-19 Mortality: The Role of Diet, Obesity and Depression

“…Clues regarding the mechanisms linking depression and poor outcomes in COVID-19 may be inferred from observational studies. For example, a recent study in a large Spanish sample of COVID-19 inpatients (n = 2150) found that a history of depression, but not the presence of de novo depressive symptoms, was associated with mortality [61]. This suggests that the pathways linking depression and increased mortality are not necessarily related to the current presence or severity of depressive symptoms, but to factors of a longer duration.…”