Selective Serotonin Reuptake Inhibitors may reduce severity of COVID-19

Covid -19 Pandemic has caused lot of mental health instability, fear of the disease and lockdown caused depression in most of the patients. Use of antidepressants have increased in the pandemic. Antidepressant use is known to reduce levels of several proinflammatory cytokines suggested to be involved with the development of severe COVID-19.

A retrospective cohort study by Dr Tomiko Oskotsky, MD and team has revealed that Selective Serotonin Reuptake Inhibitors (SSRIs) might be associated with reduced severity of COVID-19 reflected in the reduced risk of mortality. However, further research and randomized clinical trials are needed to elucidate the effect of Covid-19 outcomes specifically that of fluoxetine and fluvoxamine.

The findings of the study are published in JAMA Network Open.

The objective of the study was to investigate the association of SSRIs with outcomes in patients with COVID-19 by analyzing electronic health records (EHRs).

The study was retrospective cohort study used propensity score matching by demographic characteristics, comorbidities, and medication indication to compare SSRI-treated patients with matched control patients not treated with SSRIs within a large EHR database representing a diverse population of 83 584 patients diagnosed with COVID-19 from January to September 2020 and with a duration of follow-up of as long as 8 months in 87 health care centers across the US. Selective serotonin reuptake inhibitors were fluoxetine, fluoxetine or fluvoxamine, and other SSRIs (ie, not fluoxetine or fluvoxamine). The main outcome was death.

The results of the study were

• A total of 3401 adult patients with COVID-19 prescribed SSRIs (2033 women were identified, with 470 receiving fluoxetine only, 481 receiving fluoxetine or fluvoxamine, and 2898 receiving other SSRIs (1733 women) within a defined time frame.

• When compared with matched untreated control patients, relative risk (RR) of mortality was reduced among patients prescribed any SSRI (497 of 3401 vs 1130 of 6802; RR, 0.92; adjusted P = .03);

• Fluoxetine (46 of 470 vs 937 of 7050; RR, 0.72; adjusted P = .03).

• Fluoxetine or fluvoxamine (48 of 481 vs 956 of 7215; RR, 0.74; adjusted P = .04). The association between receiving any SSRI that is not fluoxetine or fluvoxamine.

• Risk of death was not statistically significant (447 of 2898 vs 1474 of 8694; RR, 0.92; adjusted P = .06).

Oskotsky and team concluded that "These results support evidence that SSRIs may be associated with reduced severity of COVID-19 reflected in the reduced RR of mortality. Further research and randomized clinical trials are needed to elucidate the effect of SSRIs generally, or more specifically of fluoxetine and fluvoxamine, on the severity of COVID-19 outcomes."

Reference: Oskotsky T, Marić I, Tang A, et al. Mortality Risk Among Patients With COVID-19 Prescribed Selective Serotonin Reuptake Inhibitor Antidepressants. JAMA Netw Open. 2021;4(11):e2133090. doi:10.1001/jamanetworkopen.2021.33090