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Fu L, Baranova A, Cao H, Zhang F. Exploring the causal effects of depression and antidepressants on COVID-19. J Affect Disord 2024; 359:350-355. [PMID: 38801921 DOI: 10.1016/j.jad.2024.05.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/21/2024] [Accepted: 05/23/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND While existing studies have suggested an increased risk of COVID-19 in patients with depression, the causal impact of MDD on the severity of COVID-19 remains to be validated. Additionally, the potential impact of antidepressant medication on the risk of COVID-19 is not known. METHODS In our study, we applied a Mendelian Randomization (MR) method, leveraging summary data from GWAS, to evaluate the potential causal effects of depression on three COVID-19 outcomes. Furthermore, we investigated the causal effects of antidepressants on COVID-19 outcomes. The COVID-19 datasets contain information on various stages of the disease, including SARS-CoV-2 infection (N = 2,597,856), hospitalized COVID-19 (N = 2,095,324), and critical COVID-19 (N = 1,086,211). Datasets for depression and antidepressants were comprised of 1,349,887 and 106,785 participants, respectively. RESULTS Employing the inverse variance-weighted (IVW) method, we show a causal association between depression and three COVID-19 outcomes. Specifically, we found that genetic liability to depression is linked to critical COVID-19 (OR: 1.28, 95 % CI: 1.13-1.46), hospitalized COVID-19 (OR: 1.23, 95 % CI: 1.13-1.34), and SARS-CoV-2 infection (OR: 1.06, 95 % CI: 1.02-1.10). Interestingly, the use of antidepressants was not associated with COVID-19, with the odds ratios for critical COVID-19 (OR: 1.05, 95 % CI: 0.88-1.26), hospitalization (OR: 1.01, 95 % CI: 0.90-1.13), and SARS-CoV-2 infection (OR: 1.03, 95 % CI: 0.99-1.08) indicating no causal impact. CONCLUSION Our study indicates that genetic liability to depression may increase the susceptibility to COVID-19 and its severe forms. The lack of causal effect of antidepressant use on COVID-19 implies antidepressant medication may counteract the detrimental effect of depression on COVID-19.
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Affiliation(s)
- Li Fu
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Ancha Baranova
- School of Systems Biology, George Mason University, Manassas, VA 20110, USA; Research Centre for Medical Genetics, Moscow 115478, Russia
| | - Hongbao Cao
- School of Systems Biology, George Mason University, Manassas, VA 20110, USA
| | - Fuquan Zhang
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China; Institute of Neuropsychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.
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Siripongboonsitti T, Tawinprai K, Payoong P, Mahanonda N. The real-world effectiveness of fluvoxamine therapy in mild to moderate COVID-19 patients; A historical cohort study (Fluvoxa Trial). J Infect Public Health 2023; 16:2010-2016. [PMID: 37890224 DOI: 10.1016/j.jiph.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Fluvoxamine (FVX) has been proposed as a potential treatment for severe COVID-19 by the σ-1 receptor agonist, which can reduce cytokine production. However, the efficacy of FVX remains controversial. METHODS A historical retrospective cohort study was conducted in mild to moderate COVID-19 patients, 2:1 ratio of standard of care (SOC) and FVX treatments to assess the effectiveness of FVX in preventing deterioration by the fifth day of treatment. RESULTS Of 752 eligible patients, 234 received FVX while 518 received SOC, and there was no significant difference in the effectiveness of FVX and SOC in preventing clinical deterioration. On the fifth day after treatment, 86.1 % of patients in the FVX-treated group did not experience clinical deterioration compared to 78.7 % in the SOC group. Notably, the FVX group had higher rates of pneumonia development and hospitalization, requiring more oxygen supplementation while showing less reduction in viral shedding than the SOC group. However, no difference in mechanical ventilation use, ICU admission, and survival was observed. CONCLUSION Fluvoxamine treatment is failed to demonstrate effectiveness in preventing deterioration in mild to moderate COVID-19 and may lead to a higher incidence of pneumonia, hospitalization, and oxygen supplementation, necessitating careful consideration before prescribing the drug for COVID-19.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Paruspak Payoong
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
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Mueller JK, Ahrens KF, Bauer M, Baune BT, Borgwardt S, Deckert J, Domschke K, Ellwanger R, Fallgatter A, Frodl T, Gallinat J, Gottschalk R, Grabe HJ, Hasan A, Herpertz SC, Hurlemann R, Jessen F, Kambeitz J, Kircher T, Kornhuber J, Lieb K, Meyer-Lindenberg A, Rupprecht R, Scherbaum N, Schlang C, Schneider A, Schomerus G, Thoma A, Unterecker S, Walter M, Walter H, Reif A, Reif-Leonhard C. Prevalence of COVID-19 and Psychotropic Drug Treatment in Psychiatric In-patients in Germany in 2020: Results from a Nationwide Pilot Survey. PHARMACOPSYCHIATRY 2023; 56:227-238. [PMID: 37944561 DOI: 10.1055/a-2177-3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In patients with a pre-existing mental disorder, an increased risk for a first manifestation of a psychiatric disorder in COVID-19 patients, a more severe course of COVID-19 and an increased mortality have been described. Conversely, observations of lower COVID-19 incidences in psychiatric in-patients suggested protective effects of psychiatric treatment and/or psychotropic drugs against COVID-19. METHODS A retrospective multi-center study was conducted in 24 German psychiatric university hospitals. Between April and December 2020 (the first and partly second wave of COVID-19), the effects of COVID-19 were assessed on psychiatric in-patient care, the incidence and course of a SARS-CoV-2 infection, and treatment with psychotropic drugs. RESULTS Patients (n=36,322) were admitted to the hospitals. Mandatory SARS-CoV-2 tests before/during admission were reported by 23 hospitals (95.8%), while 18 (75%) conducted regular testing during the hospital stay. Two hundred thirty-two (0.6%) patients were tested SARS-CoV-2-positive. Thirty-seven (16%) patients were receiving medical treatment for COVID-19 at the psychiatric hospital, ten (4.3%) were transferred to an intermediate/intensive care unit, and three (1.3%) died. The most common prescription for SARS-CoV-2-positive patients was for second-generation antipsychotics (n=79, 28.2%) and antidepressants (SSRIs (n=38, 13.5%), mirtazapine (n=36, 12.9%) and SNRIs (n=29, 10.4%)). DISCUSSION Contrary to previous studies, our results showed a low number of infections and mortality in SARS-CoV-2-positive psychiatric patients. Several preventive measures seem effective to protect this vulnerable group. Our observations are compatible with the hypothesis of a protective effect of psychotropic drugs against COVID-19 as the overall mortality and need for specific medical treatment was low.
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Affiliation(s)
- Juliane K Mueller
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Kira F Ahrens
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University Hospital Münster, University of Münster, Münster, Germany
| | - Stefan Borgwardt
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Andreas Fallgatter
- Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tübingen, Tübingen, Germany; German Center for Mental Health (DZPG)
| | - Thomas Frodl
- Department of Psychiatry, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH, University Aachen, Aachen, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Gottschalk
- Health Protection Authority, City of Frankfurt am Main, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Rene Hurlemann
- Department of Psychiatry, School of Medicine & Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nuremberg, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz
| | - Andreas Meyer-Lindenberg
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University Regensburg, Regensburg, Germany
| | - Norbert Scherbaum
- Department of Psychiatry and Psychotherapy, LVR-Hospital Essen, Medical Faculty, University of Duisburg Essen, Essen, Germany
| | | | - Anja Schneider
- Department of Neurodegeneration and Geriatric Psychiatry, University of Bonn, Bonn, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Andreas Thoma
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Henrik Walter
- Charité University Clinic Berlin, Freie Universität Berlin, Humboldt- Universität zu Berlin
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
| | - Christine Reif-Leonhard
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt/M, Germany
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Sánchez-Rico M, Edán-Sánchez A, Olfson M, Alvarado JM, Airagnes G, Rezaei K, Delcuze A, Peyre H, Limosin F, Hoertel N. Antipsychotic use and 28-day mortality in patients hospitalized with COVID-19: A multicenter observational retrospective study. Eur Neuropsychopharmacol 2023; 75:93-104. [PMID: 37713738 PMCID: PMC10272945 DOI: 10.1016/j.euroneuro.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 09/17/2023]
Abstract
Prior research has yielded conflicting results about the potential influence of antipsychotics in patients with COVID-19. In this multicenter retrospective study, we examined the association of antipsychotic use at admission with 28-day all-cause mortality in a sample of 59,021 adult patients hospitalized with COVID-19 from January 2020 to November 2021. In a 1:1 ratio matched analytic sample (N=1,454) accounting for age, sex, hospital, hospitalization period, the Elixhauser Comorbidity Index, other psychotropic medications, medications prescribed according to compassionate use or as part of a clinical trial, current diagnoses of psychiatric disorders, and clinical and biological markers of COVID-19 severity, antipsychotic use was not associated with 28-day mortality [23.5% (N=727) versus 18.6% (N=727); OR=1.16; 95%CI=0.89-1.51; p=0.280]. This association remained non-significant in exploratory analyses across all classes of antipsychotics and individual molecules, except for typical antipsychotics and loxapine, which were significantly linked to increased 28-day mortality, associations likely due to residual indication bias. Contrariwise, antipsychotics prescribed at daily doses higher than 200 mg of chlorpromazine-equivalents might be associated with reduced 28-day mortality when compared to patients not taking antipsychotics in the matched analytic sample [10.4% (N=154) versus 18.6% (N=727); AOR=0.56; 95%CI=0.31-0.96; p=0.040]. These results suggest that antipsychotic use, when prescribed at usual doses, are not be associated with 28-day mortality in patients hospitalized with COVID-19.
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Affiliation(s)
- Marina Sánchez-Rico
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France; Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain.
| | - Alejandro Edán-Sánchez
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France; Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
| | - Jesús M Alvarado
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - Guillaume Airagnes
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France; Université Paris Cité, Paris, France
| | - Katayoun Rezaei
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France
| | - Aude Delcuze
- CLINEA, Clinique Les Orchidées, Service de Psychiatrie, Andilly, France
| | | | - Frédéric Limosin
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; Université Paris Cité, Paris, France
| | - Nicolas Hoertel
- AP-HP, AP-HP Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Service de Psychiatrie et Addictologie, 92130 Issy-les-Moulineaux, France; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York; INSERM UMR_1266, Institut de Psychiatrie et Neuroscience de Paris, F-75014 Paris, France
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Siripongboonsitti T, Ungtrakul T, Tawinprai K, Nimmol T, Buttakosa M, Sornsamdang G, Jarrusrojwuttikul T, Silapant P, Mahanonda N. Efficacy of combination therapy of fluvoxamine and favipiravir vs favipiravir monotherapy to prevent severe COVID-19 among mild to moderate COVID-19 patients: Open-label randomized controlled trial (EFFaCo study). Int J Infect Dis 2023; 134:211-219. [PMID: 37393041 DOI: 10.1016/j.ijid.2023.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/05/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
OBJECTIVES Fluvoxamine (FVX) is an antidepressant proposed to its immunomodulatory effects in preventing deterioration in mild and moderate COVID-19. METHODS An open-label, 1:1 randomized controlled trial was assigned either combination therapy 50 mg twice daily of FVX for 10 days and favipiravir (FPV) or FPV alone to assess the efficacy in preventing disease progression in mild to moderate COVID-19 on the 5th day. RESULTS In total, 134 patients with mild COVID-19 received FPV and 132 received FVX/FPV, 31 patients with moderate COVID-19 received FPV/dexamethasone (FPV/Dex), and 30 received FVX/FPV/Dex. The intention-to-treat (ITT) analysis showed no difference of no clinical deterioration on the 5th day in both mild COVID-19 (100% in FPV vs 97% in FVX/FPV) and moderate COVID-19 (83.9% in FPV/Dex vs 86.7% in FVX/FPV/Dex). However, there was a low rate of oxygen supplemental, hospitalization, or intensive care in both groups and zero death in all groups. No significant difference in oxygen supplemental, hospitalization, radiological, virological, or biochemical outcomes, and the immunomodulatory effect was observed between the group. CONCLUSION The combined fluvoxamine treatment did not add benefit in preventing deterioration in patients with mild to moderate COVID-19 without the immunomodulatory effect observed, although it demonstrated low hospitalization rates, oxygen supplemental, intensive care needed, and zero mortality. TRIAL REGISTRATION Thai clinical trials registry (TCTR) no. 20210615002.
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Affiliation(s)
- Taweegrit Siripongboonsitti
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand; Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand.
| | - Teerapat Ungtrakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Kriangkrai Tawinprai
- Division of Infectious Diseases, Department of Medicine, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tararin Nimmol
- Pharmacy Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Mullika Buttakosa
- Nursing Department, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Gaidganok Sornsamdang
- Central Laboratory Center, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Tanadul Jarrusrojwuttikul
- Faculty of Health Science Technology, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Radiology, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
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Hoertel N, Rezaei K, Sánchez-Rico M, Delgado-Álvarez A, Kornhuber J, Gulbins E, Olfson M, Ouazana-Vedrines C, Carpinteiro A, Cougoule C, Becker KA, Alvarado JM, Limosin F. Medications Modulating the Acid Sphingomyelinase/Ceramide System and 28-Day Mortality among Patients with SARS-CoV-2: An Observational Study. Pharmaceuticals (Basel) 2023; 16:1107. [PMID: 37631022 PMCID: PMC10458150 DOI: 10.3390/ph16081107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/12/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Prior evidence indicates the potential central role of the acid sphingomyelinase (ASM)/ceramide system in the infection of cells with SARS-CoV-2. We conducted a multicenter retrospective observational study including 72,105 adult patients with laboratory-confirmed SARS-CoV-2 infection who were admitted to 36 AP-HP (Assistance Publique-Hôpitaux de Paris) hospitals from 2 May 2020 to 31 August 2022. We examined the association between the ongoing use of medications functionally inhibiting acid sphingomyelinase (FIASMA), which reduces the infection of cells with SARS-CoV-2 in vitro, upon hospital admission with 28-day all-cause mortality in a 1:1 ratio matched analytic sample based on clinical characteristics, disease severity and other medications (N = 9714). The univariate Cox regression model of the matched analytic sample showed that FIASMA medication use at admission was associated with significantly lower risks of 28-day mortality (HR = 0.80; 95% CI = 0.72-0.88; p < 0.001). In this multicenter observational study, the use of FIASMA medications was significantly and substantially associated with reduced 28-day mortality among adult patients hospitalized with COVID-19. These findings support the continuation of these medications during the treatment of SARS-CoV-2 infections. Randomized clinical trials (RCTs) are needed to confirm these results, starting with the molecules with the greatest effect size in the study, e.g., fluoxetine, escitalopram, and amlodipine.
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Affiliation(s)
- Nicolas Hoertel
- INSERM U1266, Université Paris Cité, F-75014 Paris, France
- Service de Psychiatrie et Addictologie de l’Adulte et du Sujet Agé, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, GHU APHP.Centre, F-92130 Issy-les-Moulineaux, France
| | - Katayoun Rezaei
- Service de Psychiatrie et Addictologie de l’Adulte et du Sujet Agé, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, GHU APHP.Centre, F-92130 Issy-les-Moulineaux, France
| | - Marina Sánchez-Rico
- Service de Psychiatrie et Addictologie de l’Adulte et du Sujet Agé, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, GHU APHP.Centre, F-92130 Issy-les-Moulineaux, France
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, 28223 Madrid, Spain
| | - Alfonso Delgado-Álvarez
- Service de Psychiatrie et Addictologie de l’Adulte et du Sujet Agé, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, GHU APHP.Centre, F-92130 Issy-les-Moulineaux, France
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, 28223 Madrid, Spain
- Department of Biological and Health Psychology, Faculty of Psychology, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany
| | - Erich Gulbins
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany (K.A.B.)
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA
| | - Charles Ouazana-Vedrines
- Service de Psychiatrie de l’Adulte, DMU Psychiatrie et Addictologie, Hôpital Hôtel-Dieu, AP-HP, Université Paris Cité, F-75004 Paris, France
| | - Alexander Carpinteiro
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany (K.A.B.)
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Céline Cougoule
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Katrin Anne Becker
- Institute of Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany (K.A.B.)
| | - Jesús M. Alvarado
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, 28223 Madrid, Spain
| | - Frédéric Limosin
- INSERM U1266, Université Paris Cité, F-75014 Paris, France
- Service de Psychiatrie et Addictologie de l’Adulte et du Sujet Agé, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, GHU APHP.Centre, F-92130 Issy-les-Moulineaux, France
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Sánchez-Rico M, Rezaei K, Delgado-Álvarez A, Limosin F, Hoertel N, Alvarado JM. Comorbidity Patterns and Mortality Among Hospitalized Patients with Psychiatric Disorders and COVID-19. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2023; 45. [PMID: 37290011 PMCID: PMC10668315 DOI: 10.47626/1516-4446-2023-3076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To examine the association between psychiatric and non-psychiatric comorbidity and 28-day mortality among patients with psychiatric disorders and COVID-19. METHODS We performed a multicenter observational retrospective cohort study of adult patients with psychiatric disorders hospitalized with laboratory-confirmed COVID-19 at 36 Greater Paris University hospitals (January 2020-May 2021) (N=3,768). First, we searched for different subgroups of patients according to their psychiatric and non-psychiatric comorbidities through cluster analysis. Next, we compared 28-day all-cause mortality rates across the identified clusters, while taking into account sex, age, and the number of medical conditions. RESULTS We found 5 clusters of patients with distinct psychiatric and non-psychiatric comorbidity patterns. Twenty-eight-day mortality in the cluster of patients with mood disorders was significantly lower than in other clusters. There were no significant differences in mortality across other clusters. CONCLUSIONS All psychiatric and non-psychiatric conditions may be associated with increased mortality in patients with psychiatric disorders and COVID-19. The lower risk of death among patients with mood disorders might be in line with the potential beneficial effect of certain antidepressants in COVID-19, but requires further research. These findings help identify at-risk patients with psychiatric disorders who should benefit from vaccine booster prioritization and other prevention measures.
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Affiliation(s)
- Marina Sánchez-Rico
- Département Médico-Universitaire de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Departamento de Psicobiología y Ciencias del Comportamiento, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Katayoun Rezaei
- Département Médico-Universitaire de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
| | - Alfonso Delgado-Álvarez
- Departamento de Psicobiología y Ciencias del Comportamiento, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Frédéric Limosin
- Département Médico-Universitaire de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Institut National de la Santé et de la Recherche Médicale 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, Unité de Formation et de Recherche de Médecine, Université Paris Cité, Paris, France
| | - Nicolas Hoertel
- Département Médico-Universitaire de Psychiatrie et Addictologie, Assistance Publique-Hôpitaux de Paris, Hôpital Corentin-Celton, Issy-les-Moulineaux, France
- Institut National de la Santé et de la Recherche Médicale 1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
- Faculté de Santé, Unité de Formation et de Recherche de Médecine, Université Paris Cité, Paris, France
| | - Jesús M. Alvarado
- Departamento de Psicobiología y Ciencias del Comportamiento, Facultad de Psicología, Universidad Complutense de Madrid, Campus de Somosaguas, Pozuelo de Alarcon, Spain
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8
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Schultebraucks K, Blekic W, Basaraba C, Corbeil T, Khan Z, Henry BF, Krawczyk N, Rivera BD, Allen B, Arout C, Pincus HA, Martinez DM, Levin FR. The impact of preexisting psychiatric disorders and antidepressant use on COVID-19 related outcomes: a multicenter study. Mol Psychiatry 2023; 28:2462-2468. [PMID: 37069343 PMCID: PMC10107583 DOI: 10.1038/s41380-023-02049-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 04/19/2023]
Abstract
Pre-existing mental disorders are linked to COVID-19-related outcomes. However, the findings are inconsistent and a thorough analysis of a broader spectrum of outcomes such as COVID-19 infection severity, morbidity, and mortality is required. We investigated whether the presence of psychiatric diagnoses and/or the use of antidepressants influenced the severity of the outcome of COVID-19. This retrospective cohort study evaluated electronic health records from the INSIGHT Clinical Research Network in 116,498 individuals who were diagnosed with COVID-19 between March 1, 2020, and February 23, 2021. We examined hospitalization, intubation/mechanical ventilation, acute kidney failure, severe sepsis, and death as COVID-19-related outcomes. After using propensity score matching to control for demographics and medical comorbidities, we used contingency tables to assess whether patients with (1) a history of psychiatric disorders were at higher risk of more severe COVID-19-related outcomes and (2) if use of antidepressants decreased the risk of more severe COVID-19 infection. Pre-existing psychiatric disorders were associated with an increased risk for hospitalization, and subsequent outcomes such as acute kidney failure and severe sepsis, including an increased risk of death in patients with schizophrenia spectrum disorders or bipolar disorders. The use of antidepressants was associated with significantly reduced risk of sepsis (p = 0.033), death (p = 0.026). Psychiatric disorder diagnosis prior to a COVID-19-related healthcare encounter increased the risk of more severe COVID-19-related outcomes as well as subsequent health complications. However, there are indications that the use of antidepressants might decrease this risk. This may have significant implications for the treatment and prognosis of patients with COVID-19.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Wivine Blekic
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Cale Basaraba
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Tom Corbeil
- Area Mental Health Data Science, New York State Psychiatric Institute, New York, NY, USA
| | - Zain Khan
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Brandy F Henry
- Rehabilitation and Human Services, Educational Psychology, Counseling, and Special Education, College of Education Consortium on Substance Use and Addiction, Social Science Research Institute, Pennsylvania State University, State College, PA, USA
| | - Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Bianca D Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Bennett Allen
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Caroline Arout
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Harold Alan Pincus
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Diana M Martinez
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Frances R Levin
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
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9
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Padhi S, Nayak N, Sarangi S, Nahak SK, Pati A, Pradhan B, Purohit B, Panda AK. Association of Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Related Mortality Rates With Mental Disorders: An Epidemiological Correlation in the Indian Population. J Infect Dis 2022; 226:2037-2038. [PMID: 35556123 DOI: 10.1093/infdis/jiac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/11/2022] [Indexed: 12/31/2022] Open
Affiliation(s)
- Sunali Padhi
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Nisha Nayak
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Surjyapratap Sarangi
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Suraj Kumar Nahak
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Abhijit Pati
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Bidyutprabha Pradhan
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
| | - Bishwaranjan Purohit
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Aditya K Panda
- Department of Bioscience and Bioinformatics, Berhampur University, Bhanja Bihar, Berhampur, Odisha, India
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10
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Post-traumatic stress disorder and risk for hospitalization and death following COVID-19 infection. Transl Psychiatry 2022; 12:482. [PMID: 36411283 PMCID: PMC9678873 DOI: 10.1038/s41398-022-02156-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with an increased risk for physical illnesses and early mortality. However, we do not know if it also increases the risk for adverse outcomes of coronavirus disease 2019 (COVID-19). In this retrospective cohort study, we examined associations of PTSD and other psychiatric disorders with risk for hospitalization and death in the 60 days following a COVID-19 infection in 228,367 U.S. Department of Veteran Affairs (VA) patients who tested positive for COVID-19 between February 2020 and August 2021 (age m = 60.6, 89.5% male). Generalized linear models estimated associations of PTSD and other psychiatric disorders with outcomes following a positive SARS-CoV-2 test, adjusting for socio-demographic, medical, and behavioral factors. Among 228,367 VA patients, 25.6% had PTSD, and 28.2% had a psychiatric disorder other than PTSD. In the 60 days following a positive COVID-19 test, 15% of patients were hospitalized, and 6% died. Patients with PTSD had an increased risk for both hospitalization (adjusted relative risk, ARR = 1.18, 95% CI 1.15-1.21) and death (ARR = 1.13, 95% CI 1.08-1.19) relative to those with no psychiatric disorders, adjusting for socio-demographics. Estimates remained significant when models were additionally adjusted for medical comorbidities and smoking. Patients with other psychiatric disorders also had an increased risk of adverse COVID-19 outcomes, with larger effect sizes than PTSD in older (≥65 years) but not younger patients. In this large-scale study of VA patients, individuals with PTSD, and other psychiatric disorders, had heightened vulnerability to severe adverse outcomes of COVID-19; thus, individuals with PTSD should also be considered at higher risk for severe COVID-19 outcomes, and potentially prioritized for vaccination, screening, and early treatment intervention for COVID-19.
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11
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Péricat D, Leon-Icaza SA, Sanchez Rico M, Mühle C, Zoicas I, Schumacher F, Planès R, Mazars R, Gros G, Carpinteiro A, Becker KA, Izopet J, Strub-Wourgaft N, Sjö P, Neyrolles O, Kleuser B, Limosin F, Gulbins E, Kornhuber J, Meunier E, Hoertel N, Cougoule C. Antiviral and Anti-Inflammatory Activities of Fluoxetine in a SARS-CoV-2 Infection Mouse Model. Int J Mol Sci 2022; 23:13623. [PMID: 36362409 PMCID: PMC9657171 DOI: 10.3390/ijms232113623] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/11/2022] [Accepted: 10/26/2022] [Indexed: 08/27/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to cause significant morbidity and mortality worldwide. Since a large portion of the world's population is currently unvaccinated or incompletely vaccinated and has limited access to approved treatments against COVID-19, there is an urgent need to continue research on treatment options, especially those at low cost and which are immediately available to patients, particularly in low- and middle-income countries. Prior in vitro and observational studies have shown that fluoxetine, possibly through its inhibitory effect on the acid sphingomyelinase/ceramide system, could be a promising antiviral and anti-inflammatory treatment against COVID-19. In this report, we evaluated the potential antiviral and anti-inflammatory activities of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and against variants of concern in vitro, i.e., SARS-CoV-2 ancestral strain, Alpha B.1.1.7, Gamma P1, Delta B1.617 and Omicron BA.5. Fluoxetine, administrated after SARS-CoV-2 infection, significantly reduced lung tissue viral titres and expression of several inflammatory markers (i.e., IL-6, TNFα, CCL2 and CXCL10). It also inhibited the replication of all variants of concern in vitro. A modulation of the ceramide system in the lung tissues, as reflected by the increase in the ratio HexCer 16:0/Cer 16:0 in fluoxetine-treated mice, may contribute to explain these effects. Our findings demonstrate the antiviral and anti-inflammatory properties of fluoxetine in a K18-hACE2 mouse model of SARS-CoV-2 infection, and its in vitro antiviral activity against variants of concern, establishing fluoxetine as a very promising candidate for the prevention and treatment of SARS-CoV-2 infection and disease pathogenesis.
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Affiliation(s)
- David Péricat
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Stephen Adonai Leon-Icaza
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Marina Sanchez Rico
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Département de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Agé, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 75014 Paris, France
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Iulia Zoicas
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Fabian Schumacher
- Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Str. 2-4, 14195 Berlin, Germany
| | - Rémi Planès
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Raoul Mazars
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Germain Gros
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Alexander Carpinteiro
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Katrin Anne Becker
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Jacques Izopet
- Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Université Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France
- Laboratoire de Virologie, CHU Toulouse, Hôpital Purpan, 31300 Toulouse, France
| | | | - Peter Sjö
- Drugs for Neglected Diseases Initiative, 1202 Geneva, Switzerland
| | - Olivier Neyrolles
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Burkhard Kleuser
- Institute of Pharmacy, Freie Universität Berlin, Königin-Luise-Str. 2-4, 14195 Berlin, Germany
| | - Frédéric Limosin
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Département de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Agé, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 75014 Paris, France
| | - Erich Gulbins
- Institute for Molecular Biology, University Medicine Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Etienne Meunier
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
| | - Nicolas Hoertel
- Faculté de Santé, Université Paris Cité, 75006 Paris, France
- Département de Psychiatrie et d’Addictologie de l’Adulte et du Sujet Agé, Assistance Publique-Hôpitaux de Paris (AP-HP), DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, 92130 Issy-les-Moulineaux, France
- INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, 75014 Paris, France
| | - Céline Cougoule
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31000 Toulouse, France
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12
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Hoertel N, Sánchez-Rico M, Kornhuber J, Gulbins E, Reiersen AM, Lenze EJ, Fritz BA, Jalali F, Mills EJ, Cougoule C, Carpinteiro A, Mühle C, Becker KA, Boulware DR, Blanco C, Alvarado JM, Strub-Wourgaft N, Lemogne C, Limosin F. Antidepressant Use and Its Association with 28-Day Mortality in Inpatients with SARS-CoV-2: Support for the FIASMA Model against COVID-19. J Clin Med 2022; 11:5882. [PMID: 36233753 PMCID: PMC9572995 DOI: 10.3390/jcm11195882] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/29/2023] Open
Abstract
To reduce Coronavirus Disease 2019 (COVID-19)-related mortality and morbidity, widely available oral COVID-19 treatments are urgently needed. Certain antidepressants, such as fluvoxamine or fluoxetine, may be beneficial against COVID-19. We included 388,945 adult inpatients who tested positive for SARS-CoV-2 at 36 AP−HP (Assistance Publique−Hôpitaux de Paris) hospitals from 2 May 2020 to 2 November 2021. We compared the prevalence of antidepressant use at admission in a 1:1 ratio matched analytic sample with and without COVID-19 (N = 82,586), and assessed its association with 28-day all-cause mortality in a 1:1 ratio matched analytic sample of COVID-19 inpatients with and without antidepressant use at admission (N = 1482). Antidepressant use was significantly less prevalent in inpatients with COVID-19 than in a matched control group of inpatients without COVID-19 (1.9% versus 4.8%; Odds Ratio (OR) = 0.38; 95%CI = 0.35−0.41, p < 0.001). Antidepressant use was significantly associated with reduced 28-day mortality among COVID-19 inpatients (12.8% versus 21.2%; OR = 0.55; 95%CI = 0.41−0.72, p < 0.001), particularly at daily doses of at least 40 mg fluoxetine equivalents. Antidepressants with high FIASMA (Functional Inhibitors of Acid Sphingomyelinase) activity seem to drive both associations. These treatments may reduce SARS-CoV-2 infections and COVID-19-related mortality in inpatients, and may be appropriate for prophylaxis and/or COVID-19 therapy for outpatients or inpatients.
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Affiliation(s)
- Nicolas Hoertel
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, F-75014 Paris, France
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, F-92130 Paris, France
| | - Marina Sánchez-Rico
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, F-92130 Paris, France
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, 28223 Pozuelo de Alarcón (Madrid), Spain
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany
| | - Erich Gulbins
- Institute for Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Angela M. Reiersen
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Bradley A. Fritz
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Farid Jalali
- Department of Gastroenterology, Saddleback Medical Group, Laguna Hills, CA 92653, USA
| | - Edward J. Mills
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Céline Cougoule
- Institut de Pharmacologie et de Biologie Structurale (IPBS), Université de Toulouse, F-31400 Toulouse, France
| | - Alexander Carpinteiro
- Institute for Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg (FAU), 91054 Erlangen, Germany
| | - Katrin Anne Becker
- Institute for Molecular Biology, University Hospital Essen, University of Duisburg-Essen, 47057 Essen, Germany
| | - David R. Boulware
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Carlos Blanco
- National Institute on Drug Abuse (NIDA), National Institutes of Health, Bethesda, MD 20852, USA
| | - Jesús M. Alvarado
- Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Pozuelo de Alarcón, 28223 Pozuelo de Alarcón (Madrid), Spain
| | - Nathalie Strub-Wourgaft
- COVID-19 Response & Pandemic Preparedness, Drugs for Neglected Diseases Initiative (DNDi), 1202 Geneva, Switzerland
| | - Cédric Lemogne
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, F-75014 Paris, France
- Service de Psychiatrie de l’adulte, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, F-75004 Paris, France
| | - Frédéric Limosin
- Institut de Psychiatrie et Neuroscience de Paris, Université Paris Cité, INSERM U1266, F-75014 Paris, France
- AP-HP, DMU Psychiatrie et Addictologie, Hôpital Corentin-Celton, Issy-les-Moulineaux, F-92130 Paris, France
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13
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Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2. Transl Psychiatry 2022; 12:341. [PMID: 35995770 PMCID: PMC9395392 DOI: 10.1038/s41398-022-02109-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 02/08/2023] Open
Abstract
Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associated with reduced emergency department (ED) or hospital visits among ambulatory patients with SARS-CoV-2 infection. This retrospective cohort study included adult patients (N = 25 034) with a positive SARS-CoV-2 test performed in a non-hospital setting. Logistic regression analyses tested associations between home use of antidepressant medications and a composite outcome of ED visitation or hospital admission within 30 days. Secondary exposures included individual antidepressants and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. Patients with antidepressant exposure were less likely to experience the primary composite outcome compared to patients without antidepressant exposure (adjusted odds ratio [aOR] 0.89, 95% CI 0.79-0.99, p = 0.04). This association was only observed with daily doses of at least 20 mg fluoxetine-equivalent (aOR 0.87, 95% CI 0.77-0.99, p = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80-1.11, p = 0.48). In exploratory secondary analyses, the outcome incidence was also reduced with exposure to selective serotonin reuptake inhibitors (aOR 0.87, 95% CI 0.75-0.99, p = 0.04), bupropion (aOR 0.70, 95% CI 0.55-0.90, p = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77-0.99, p = 0.03). Antidepressant exposure was associated with a reduced incidence of emergency department visitation or hospital admission among SARS-CoV-2 positive patients, in a dose-dependent manner. These data support the FIASMA model of antidepressants' effects against COVID-19.
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14
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Mahdi M, Hermán L, Réthelyi JM, Bálint BL. Potential Role of the Antidepressants Fluoxetine and Fluvoxamine in the Treatment of COVID-19. Int J Mol Sci 2022; 23:ijms23073812. [PMID: 35409171 PMCID: PMC8998734 DOI: 10.3390/ijms23073812] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Mapping non-canonical cellular pathways affected by approved medications can accelerate drug repurposing efforts, which are crucial in situations with a global impact such as the COVID-19 pandemic. Fluoxetine and fluvoxamine are well-established and widely-used antidepressive agents that act as serotonin reuptake inhibitors (SSRI-s). Interestingly, these drugs have been reported earlier to act as lysosomotropic agents, inhibitors of acid sphingomyelinase in the lysosomes, and as ligands of sigma-1 receptors, mechanisms that might be used to fight severe outcomes of COVID-19. In certain cases, these drugs were administered for selected COVID-19 patients because of their antidepressive effects, while in other cases, clinical studies were performed to assess the effect of these drugs on treating COVID-19 patients. Clinical studies produced promising data that encourage the further investigation of fluoxetine and fluvoxamine regarding their use in COVID-19. In this review, we summarize experimental data and the results of the performed clinical studies. We also provide an overview of previous knowledge on the tissue distribution of these drugs and by integrating this information with the published experimental results, we highlight the real opportunity of using these drugs in our fight against COVID-19.
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Affiliation(s)
- Mohamed Mahdi
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary;
- Infectology Clinic, University of Debrecen Clinical Centre, Bartók Béla út 2-26, 4031 Debrecen, Hungary
| | - Levente Hermán
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary;
| | - János M. Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary;
- Correspondence: (J.M.R.); (B.L.B.)
| | - Bálint László Bálint
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Egyetem tér 1, 4032 Debrecen, Hungary;
- Department of Bioinformatics, Semmelweis University, Tűzoltó utca 7-9, 1094 Budapest, Hungary
- Correspondence: (J.M.R.); (B.L.B.)
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15
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Hoertel N, Sánchez-Rico M, Gulbins E, Kornhuber J, Carpinteiro A, Abellán M, de la Muela P, Vernet R, Beeker N, Neuraz A, Delcuze A, Alvarado JM, Cougoule C, Meneton P, Limosin F. Association between FIASMA psychotropic medications and reduced risk of intubation or death in individuals with psychiatric disorders hospitalized for severe COVID-19: an observational multicenter study. Transl Psychiatry 2022; 12:90. [PMID: 35241663 PMCID: PMC8892828 DOI: 10.1038/s41398-022-01804-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 01/07/2022] [Accepted: 01/13/2022] [Indexed: 12/17/2022] Open
Abstract
The acid sphingomyelinase (ASM)/ceramide system may provide a useful framework for better understanding SARS-CoV-2 infection and the repurposing of psychotropic medications functionally inhibiting the acid sphingomyelinase/ceramide system (named FIASMA psychotropic medications) against COVID-19. We examined the potential usefulness of FIASMA psychotropic medications in patients with psychiatric disorders hospitalized for severe COVID-19, in an observational multicenter study conducted at Greater Paris University hospitals. Of 545 adult inpatients, 164 (30.1%) received a FIASMA psychotropic medication upon hospital admission for COVID-19. We compared the composite endpoint of intubation or death between patients who received a psychotropic FIASMA medication at baseline and those who did not in time-to-event analyses adjusted for sociodemographic characteristics, psychiatric and other medical comorbidity, and other medications. FIASMA psychotropic medication use at baseline was significantly associated with reduced risk of intubation or death in both crude (HR = 0.42; 95%CI = 0.31-0.57; p < 0.01) and primary inverse probability weighting (IPW) (HR = 0.50; 95%CI = 0.37-0.67; p < 0.01) analyses. This association was not specific to one FIASMA psychotropic class or medication. Patients taking a FIASMA antidepressant at baseline had a significantly reduced risk of intubation or death compared with those taking a non-FIASMA antidepressant at baseline in both crude (HR = 0.57; 95%CI = 0.38-0.86; p < 0.01) and primary IPW (HR = 0.57; 95%CI = 0.37-0.87; p < 0.01) analyses. These associations remained significant in multiple sensitivity analyses. Our results show the potential importance of the ASM/ceramide system framework in COVID-19 and support the continuation of FIASMA psychotropic medications in these patients and the need of large- scale clinical trials evaluating FIASMA medications, and particularly FIASMA antidepressants, against COVID-19.
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Affiliation(s)
- Nicolas Hoertel
- AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France. .,Université de Paris, Paris, France. .,INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, Paris, France.
| | - Marina Sánchez-Rico
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Erich Gulbins
- grid.5718.b0000 0001 2187 5445Institute for Molecular Biology, University Medicine Essen, University of Duisburg- Essen, Essen, Germany
| | - Johannes Kornhuber
- grid.5330.50000 0001 2107 3311Department of Psychiatry and Psychotherapy, University Hospital, Friedrich- Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alexander Carpinteiro
- grid.5718.b0000 0001 2187 5445Institute for Molecular Biology, University Medicine Essen, University of Duisburg- Essen, Essen, Germany ,grid.410718.b0000 0001 0262 7331Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Miriam Abellán
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France
| | - Pedro de la Muela
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Raphaël Vernet
- grid.414093.b0000 0001 2183 5849AP-HP.Centre-Université de Paris, Hôpital Européen Georges Pompidou, Medical Informatics, Biostatistics and Public Health Department, Paris, France
| | - Nathanaël Beeker
- grid.411784.f0000 0001 0274 3893Assistance Publique-Hopitaux de Paris, Unité de Recherche clinique, Hopital Cochin, Paris, France
| | - Antoine Neuraz
- grid.417925.cINSERM, UMR S1138, Cordeliers Research Center, Université de Paris, Paris, France ,grid.412134.10000 0004 0593 9113AP-HP.Centre-Université de Paris, Department of Medical Informatics, Necker-Enfants Malades Hospital, 75015 Paris, France
| | - Aude Delcuze
- ORPEA - CLINEA, Clinique Les Orchidées, Service de Psychiatrie, Andilly, France
| | - Jesús M. Alvarado
- grid.4795.f0000 0001 2157 7667Universidad Complutense de Madrid, Department of Psychobiology & Behavioural Sciences Methods, Faculty of Psychology, Campus de Somosaguas, Pozuelo de Alarcon, Spain
| | - Céline Cougoule
- grid.508721.9Institut de Pharmacologie et de Biologie Structurale, IPBS, Université de Toulouse, Toulouse, France
| | - Pierre Meneton
- grid.462844.80000 0001 2308 1657INSERM U1142 LIMICS, UMR S1142, Sorbonne Universities, UPMC University of Paris 06, University of Paris 13, Paris, France
| | - Frédéric Limosin
- grid.413885.30000 0000 9731 7223AP-HP, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Département de Psychiatrie, Issy-les-Moulineaux, France ,grid.508487.60000 0004 7885 7602Université de Paris, Paris, France ,grid.512035.0INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266 Paris, France
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