key: cord-0790822-w3qgvme3
authors: Lenze, Eric J.; Reiersen, Angela M.; Facente, Shelley N.
title: Authors’ Reply to Mazza et al.: “Fluvoxamine for the Early Treatment of SARS‑CoV‑2 Infection: A Review of Current Evidence”
date: 2022-02-12
journal: Drugs
DOI: 10.1007/s40265-022-01681-8
sha: 46a7e8c54b18259e3d28d065574622ea216d90e5
doc_id: 790822
cord_uid: w3qgvme3

nan

We appreciated the thoughtful letter by Dr. Mazza positing that the antidepressant effect of fluvoxamine could make it a useful treatment for patients experiencing depression in the wake of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) infection [1] . This highlights two important points: (1) the critical need to find effective treatments for the neuropsychiatric sequelae of COVID-19 and (2) the potential to repurpose selective serotonin reuptake inhibitors (SSRIs) and other psychotropics towards this goal.

Neuropsychiatric problems are common after COVID-19, including mood and anxiety disorders, cognitive impairment, psychosis, and stroke. A large electronic health record database study found that one in three COVID-19 survivors experienced neuropsychiatric illness after 6 months, including 17% with new-onset anxiety disorder and 14% with new-onset depression [2] . Etiologies include central inflammation, delirium, post-intensive care unit syndrome, cerebrovascular accidents, and psychosocial stress.

Dr. Mazza recently showed that "COVID depression" may be particularly responsive to SSRIs, suggesting that these drugs may have a role in reducing the substantial morbidity of post-COVID neuropsychiatric syndromes [3] . Serotonin reuptake inhibitors (SRIs) have manifold effects on human physiology, including anti-inflammatory and neurorestorative effects in some studies [4] . Some SRIs have secondary molecular targets, such as the sigma-1 receptor, which motivated our repurposing of fluvoxamine (a strong activator of this receptor) for acute COVID-19.

More studies are needed to confirm and extend the findings of Mazza et al. [1] in COVID-depression and other neuropsychiatric manifestations of this disease.

Fluvoxamine for the early treatment of SARS-CoV

infection: a review of current evidence

Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA

Rapid response to selective serotonin reuptake inhibitors in post-COVID depression

Opportunities for drug repurposing of serotonin reuptake inhibitors: potential uses in inflammation, infection, cancer, neuroprotection, and Alzheimer's disease prevention