Among patients who are infected with COVID-19, those taking certain antidepressants may be less likely to visit the emergency department (ED) or be hospitalized than those who are not taking antidepressants, according to a study published this week in Translational Psychiatry.
“Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have shown promise as early treatments for COVID-19,” wrote Bradley Fritz, M.D., M.S.C.I., of the Washington University School of Medicine and colleagues. “Because many individuals around the world have not been fully vaccinated and breakthrough infections can sometimes cause severe COVID-19 in vaccinated individuals, effective treatments with favorable tolerability profiles are urgently needed.”
Fritz and colleagues used data from the BJC Healthcare network of hospitals in Missouri and Illinois. Participants included in the study were aged 18 and older, had a positive COVID-19 test between March 2020 and May 2021, and were not admitted to the hospital on the day they tested positive. The authors used electronic health record data to determine whether the participants had an ED or hospital visit within 30 days of testing positive and to determine what medications and dosages they were taking. Antidepressant exposure was defined as inclusion of an antidepressant on patients’ medication list at any health care visit prior to the positive COVID-19 test.
A total of 25,034 participants were included in the study, 4,557 (18.3%) of whom were taking at least one antidepressant when they tested positive. The incidence of an ED or hospital visit was significantly greater among patients taking antidepressants (21.2%) compared with those who were not (9.3%). However, after adjusting for confounding variables such as sex, age, race and ethnicity, obesity, number of diagnoses, and concurrent exposure to other medications, antidepressant exposure was associated with decreased odds of an ED or hospital visit. The patients who benefited were those taking SSRIs, bupropion, and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. A daily dose equivalent to 40 mg of fluoxetine a day was associated with the strongest benefit; bupropion was associated with decreased odds of an ED or hospital encounter when taken at any dose.
“When designing future prospective studies, researchers should consider SSRIs and other antidepressants with FIASMA activity as candidate interventions for outpatient therapy of COVID-19, prescribed at a dose of at least 40 mg/day of fluoxetine-equivalents,” the authors concluded.
For related information, see the Psychiatric News article “Antidepressants May Reduce Severity of COVID-19.”