Common psychiatric drugs appear to reduce effect of COVID-19

15 December 2022

A new meta-analysis shows that psychiatric medications can give some protection against Covid-19, with the common antidepressant fluvoxamine showing the strongest effect. Patients taking fluvoxamine showed reduced symptoms, with the analysis indicating that mortality was around 15% lower than in those not taking fluvoxamine.

The analysis considered 30 clinical studies, including 145,000 patients. The resulting paper, “Psychotropic drug repurposing for Covid-19: A Systematic Review and Meta-Analysis”, is published in the January edition of the peer-reviewed journal European Neuropsychopharmacology. Here is a brief interview between the ECNP Press Officer, Tom Parkhill, and the lead author, Giovanna Fico, Spain.

TP: What are the main findings of this paper?
GF: We found that fluvoxamine may reduce the risk of severe Covid-19 outcomes and might be a good candidate for drug repurposing in Covid-19, while the increased risk for severe Covid-19 with antipsychotics is not absolute and depends on individual cases

Do you think this should change clinical practice?
Evidence on the efficacy of antidepressants for the treatment of Covid-19 is still scarce, so we cannot conclude that clinicians should start antidepressants in patients with Covid-19 infection. However, patients already on treatment with antidepressants who get infected with Covid-19, should not discontinue this treatment. There are a couple of reasons for this. Firstly, patients with depressive disorder who discontinue antidepressants have a higher risk of having another depressive episode (see here). Secondly, we know that antidepressants can be prescribed safely in patients with Covid-19. We believe it is possible that antidepressants can reduce mortality in patients with Covid-19, but the evidence is still weak.

The paper states “Fluvoxamine was associated with a reduced risk of mortality for Covid-19 (OR=0.15; CI 0.02-0.95)”. Can you tell me how this might compare to other drugs being investigated for Covid?
Many other drugs were studied as associated with a reduction in Covid-19 mortality: metformin (aRR, 0.33; 95% CI, 0.25–0.43), colchicine, angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers, statins, vitamin D, antihistamines, alpha-blockers, anti-androgens, and nonsteroidal anti-inflammatory drugs (aRR, 0.69; 95% CI, 0.61–0.78) (see here), apixaban (hazard ratio, 0.42; 95% CI, 0.363 to 0.48; corrected CI, 0.336 to 0.52) and aspirin (hazard ratio, 0.72; 95% CI, 0.60 to 0.87; corrected CI, 0.54 to 96) (see here), among others. In our meta-analysis fluvoxamine showed a low-moderate effect on the reduction of mortality for Covid-19.

I think the issue is that people who are already taking fluvoxamine should continue taking it, but what about those who don’t have a psychiatric condition? Should severely at risk people be taking it?
Several randomized clinical trials on fluvoxamine as Covid-19 treatment have been conducted (also after the publication of our meta-analysis). The last published paper on RCT on the topic (Marcec et al) stated: "Based on our reanalysis, it appears fluvoxamine is associated with a statistically significant decrease in the risk of hospitalization when given to Covid-19 outpatients." Still, I believe, we have too little evidence to make clinical recommendations to start fluvoxamine in patients at risk for severe Covid-19.



European Neuropsychopharmacology is an official journal of the European College of Neuropsychopharmacology.

The full European Neuropsychopharmacology paper can be seen online here.
Psychotropic drug repurposing for COVID-19: A Systematic Review and Meta-Analysis:
Giovanna Fico , Ulker Isayeva, Michele De Prisco, Vincenzo Oliva, Brisa Solè , Laura Montejo , Iria Grande , Nestor Arbelo, Marta Gomez-Ramiro, Luis Pintor, Bernardo Carpiniello, Mirko Manchia, Eduard Vieta, Andrea Murru

European Neuropsychopharmacology, Volume 66, January 2023, Pages 30-44.

The next ECNP annual Congress takes place in Barcelona, Spain, on 7-10 October 2023. To the Congress website.