Why an antidepressant (SSRI) could be used to treat COVID-19

Mito

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“A commonly used drug called fluvoxamine was recently tested as a treatment for COVID-19 in the United States. The 152 patients enrolled in the trial had been confirmed to have COVID-19 using a PCR test, and had seen symptoms appear within the past seven days.

Patients who already required COVID-19 hospitalisation, or who had an underlying lung condition, congestive heart failure or other immune conditions, were excluded. The study looked only at those who at the time had a relatively mild form of the disease.

Among these patients, the study found that taking fluvoxamine reduced the incidence of developing a serious COVID-19 condition over a 15-day period. None of the 80 patients treated with fluvoxamine deteriorated, whereas six (8.3%) of the 72 patients given a placebo saw their condition get worse. Their symptoms included shortness of breath, pneumonia and reduced blood oxygen.”

“Thus, it is likely that the effect seen with fluvoxamine in COVID-19 patients has nothing to do with serotonin but everything to do with inhibiting the inflammatory response through the S1R. We know from studies in mice that fluvoxamine can decrease a sepsis-induced inflammatory response and the toxicity that comes with it.”


 

Perry Staltic

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Didn't see it, maybe I missed it, but I don't trust studies that don't reveal what the placebo was.
 

Perry Staltic

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Using an SSRI like fluvoximine doesn't seem like a really great idea as treatment considering the fact that it's one step closer to serotonin syndrome (SS), which some doctors think is a factor in serious covid. Add an opioid, as hospitals are likely to do, and it very likely would become SS. Most doctors are clueless about SS and wouldn't know how to diagnose it if they saw it.

 
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Perry Staltic

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We wish to draw attention to the potential for serotonin syndrome in patients on fluvoxamine who may have previously been on other SSRIs.

 

Mito

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Didn't see it, maybe I missed it, but I don't trust studies that don't reveal what the placebo was.
Details on drug and placebo encapsulation:
100 mg fluvoxamine maleate and 50 mg fluvoxamine maleate manufactured by Apotex was pulverized and encapsulated along with microcrystalline cellulose and silica gel, micronized. Matching placebo gelatin capsules contained microcrystalline cellulose and silica gel, micronized. All active drug and placebo preparation was
performed by Medical Arts Pharmacy, 7710 Carondelet Avenue, #125, St. Louis, Missouri 63105
 

Mito

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Using an SSRI like fluvoximine doesn't seem like a really great idea as treatment considering the fact that it's one step closer to serotonin syndrome (SS), which some doctors think is a factor in serious covid. Add an opioid, as hospitals are likely to do, and it very likely would become SS. Most doctors are clueless about SS and wouldn't know how to diagnose it if they saw it.

Yes seems paradoxical. Maybe only effective early on, otherwise if later the opposite is needed i.e. cyproheptadine.

“Summary: In the fight against COVID-19, we need a simple, benign drug that could be provided widely to outpatients early in the course of mild illness, to prevent the clinical deterioration to serious and life-threatening cardiopulmonary problems. Existing clinical trials have been appropriately focused on treating more serious cases, but with few if any focusing on this clinical space. S1R agonists – of which fluvoxamine is a particularly attractive candidate - could be given early in the course of symptomatic illness, to outpatients with mild symptoms, to decrease the excessive inflammatory response with COVID-19, and potentially prevent the evolution to more serious disease. A search (on March 28; repeated April 9) of clinicaltrials.gov and the WHO International Registry of Clinical Trials (International Clinical Trials Registry Platform (ICTRP)) finds no trials – yet – of fluvoxamine, or any S1R agonist.”
 

haidut

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Some SSRI drugs are actually selective serotonin receptor antagonists. Prozac is the most famous one, being antagonist on 5-HT2C, which probably explains most of its antidepressant effects. It is really insidious as Big Pharma gets to claim increasing serotonin treats depression, while in reality the antidepressant effect is due to a under-recognized (partial) serotonin antagonism of those drugs. Some of those drugs are also GR antagonists and given the suppressive effects of cortisol on the immune system, that blockade can also produce a therapeutic effect.

Not sure what the pharmacological profile of fluvoxamine is, but these effects above could explain some of the results. The bad part if that now Big Pharma can turn around and start claiming that raising serotonin is also good for treating severe viral disease when in fact it is the exact opposite.
 

Perry Staltic

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Fluvoxamine treatment for covid seems ridiculous to me due to the narrow window. SSRI as a prophylactic? No thanks.
 

Perry Staltic

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I think Farid's hypothesis that severe covid is less likely because of platelet depletion of serotonin is flawed. It should be easily testable because those whose platelets are depleted because of chronic SSRI use should should experience less severity and mortality. I doubt that is the case.

These researchers suspect fluvoxamine may be effective because it interacts strongly with the sigma-1 receptor, which helps regulate inflammatory response.

 

Perry Staltic

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I think Farid's hypothesis that severe covid is less likely because of platelet depletion of serotonin is flawed. It should be easily testable because those whose platelets are depleted because of chronic SSRI use should should experience less severity and mortality. I doubt that is the case.

This MD's experience contradicts the hypothesis that platelet depletion of serotonin prevents serious disease (below Farid's comment).

 
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