Treatment of 95 post-Covid patients with SSRIs

Abstract

After Covid-19 infection, 12.5% develops post-Covid-syndrome (PCS). Symptoms indicate numerous affected organ systems. After a year, chronic fatigue, dysautonomia and neurological and neuropsychiatric complaints predominate. In this study, 95 PCS patients were treated with selective serotonin reuptake inhibitors (SSRIs). This study used an exploratory questionnaire and found that two-thirds of patients had a reasonably good to strong response on SSRIs, over a quarter of patients had moderate response, while 10% reported no response. Overall, patients experienced substantial improved well-being. Brainfog and sensory overload decreased most, followed by chronic fatigue and dysautonomia. Outcomes were measured with three different measures that correlated strongly with each other. The response to SSRIs in PCS conditions was explained by seven possible neurobiological mechanisms based on recent literature on PCS integrated with already existing knowledge. Important for understanding these mechanisms is the underlying biochemical interaction between various neurotransmitter systems and parts of the immune system, and their dysregulation in PCS. The main link appears to be with the metabolic kynurenine pathway (KP) which interacts extensively with the immune system. The KP uses the same precursor as serotonin: tryptophan. The KP is overactive in PCS which maintains inflammation and which causes a lack of tryptophan. Finally, potential avenues for future research to advance this line of clinical research are discussed.

Assessing the effect of selective serotonin reuptake inhibitors in the prevention of post-acute sequelae of COVID-19

“… [46] , [47] , [48] Similarly, several, [49] , [45] though not all [50] , [51] , [52] prospective, randomized, controlled investigations into the potential therapeutic effects of fluvoxamine in outpatients with acute COVID-19, have suggested evidence of benefit. A number of other investigators have been interested in the evaluating whether SSRIs prevent COVID-19, exert a treatment effect in acute infection or lower early mortality after acute COVID-19 [53] , [54] , [55] , [56] , [57] , and a recent uncontrolled study including 95 patients with PASC treated with SSRI therapy has been published [58] , but to our knowledge, ours is the first study to suggest a diminished risk of the development of Long COVID in patients receiving SSRIs at baseline (i.e., prior to SARS-CoV-2 infection). Although an immunological basis for this observation has been postulated, we acknowledge the possibility that the findings in the current study may reflect non-immunological effects of SSRIs.…”

Neurologische Langzeitfolgen von COVID-19

“…36 Teilnehmenden mit kognitiven Defiziten im Rahmen eines Post-COVID-19-Syndroms konnte mithilfe einer neuropsychologischen Testbatterie gezeigt werden, dass 40 Anwendungen der hyperbaren Sauerstofftherapie (HBOT) verteilt über einen Zeitraum von 2 Monaten positive Auswirkungen auf verschiedene kognitive Bereiche hatten [80]. In einer niederländischen Studie erhielten 95 Patient*innen mit anhaltenden Beschwerden nach einer COVID-19-Erkrankung einen selektiven Serotonin-Wiederaufnahmehemmer (SSRI) oder einen selektiven Serotonin-Noradrenalin-Wiederaufnahmehemmer und berichteten 4-6 Wochen nach der Einnahme von einer Verbesserung des allgemeinen Wohlbefindens, verschiedener Symptome und der allgemeinen Funktionalität [81].…”

“…Die Studie unterliegt einigen Einschränkungen. So wurde u. a. auf eine Kontrollbedingung verzichtet und das Ausmaß einer depressiven Stimmungslage nicht erfasst, wenngleich die Teilnehmer*innen im Allgemeinen nicht die Diagnosekriterien einer Depression erfüllten [81]. Dies erscheint insbesondere relevant, da die Wirksamkeit einer Therapie mit SSRI auf eine nach einer COVID-19-Erkrankung auftretende Depression bereits gezeigt werden konnte und somit auch ein Effekt auf subklinische depressive Verstimmungen anzunehmen ist [82].…”

From intestinal metabolites to the brain: Investigating the mysteries of Long COVID

“…A Dutch study including 95 patients showed a significant reduction in symptoms with SSRIs; however, this was not a randomised controlled trial. 9 A preprint detailing a multicentre retrospective study of 17 933 patients by the National COVID Cohort Collaborative (N3C) found a 26% reduction in the relative risk of PASC in patients who received an SSRI compared to unexposed controls. 10 Extensive, double‐blind, prospective studies are needed to establish whether SSRIs or other interventions targeting peripheral serotonin signalling could play a role in managing the long‐term disease burden of COVID‐19.…”