Impact of COVID-19 on Mental Health and Antidepressant Use

The COVID-19 pandemic has caused a lot of mental health instability. The fear of the disease and lockdown has led to depression in many patients. The use of antidepressants has increased during 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.

Study Objective

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).

Study Design

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

Study Results

• A total of 3,401 adult patients with COVID-19 were prescribed SSRIs (2,033 women were identified, with 470 receiving fluoxetine only, 481 receiving fluoxetine or fluvoxamine, and 2,898 receiving other SSRIs (1,733 women) within a defined time frame.
• When compared with matched untreated control patients, the relative risk (RR) of mortality was reduced among patients prescribed any SSRI (497 of 3,401 vs 1,130 of 6,802; RR, 0.92; adjusted P = .03).
• Fluoxetine (46 of 470 vs 937 of 7,050; RR, 0.72; adjusted P = .03).
• Fluoxetine or fluvoxamine (48 of 481 vs 956 of 7,215; 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 2,898 vs 1,474 of 8,694; 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