Could An Antidepressant Keep COVID-19 Patients off the Ventilator?
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Could An Antidepressant Keep COVID-19 Patients off the Ventilator?

Surprise Discovery

What if I told you an antidepressant that’s already widely available across America could help people suffering from COVID-19? Not for mental health problems due to COVID, but with the respiratory disease itself.

Sounds crazy, right? Not necessarily. Throughout the history of medicine and right up to the present day, many treatments have been discovered by accident. Furthermore, a drug can have more than one therapeutic benefit, even for seemingly unrelated conditions.

A study just published in the Journal of the American Medical Association (JAMA) suggests that the drug fluvoxamine (brand name Luvox[1]), a common antidepressant similar to Prozac[2], might prevent mild COVID-19 cases from becoming more severe.

While doctors usually prescribe fluvoxamine to help people struggling with Major Depression, phobias, or Obsessive-Compulsive Disorder, some studies have shown it can positively impact the immune system.

Inflammation Gone Out of Bounds

Some assaults on the body can trigger the immune system so powerfully that the response does more harm than good. When the coronavirus infects cells in the lungs, those cells release a flood of inflammatory signals. The inflammatory response causes the alveoli (tiny, sensitive air sacs in the lungs where oxygen enters, and carbon dioxide leaves our blood), to fill with fluid. Trouble breathing and cough follow, with the potential need for a ventilator (a breathing machine) if the situation gets really bad.

The researchers found that, in animal studies, fluvoxamine helped slow down this onslaught of inflammation. In short, fluvoxamine might help the body put the brakes on inflammation when the immune system starts to run amok.

An Ounce of Prevention

The study published in JAMA looked at 152 people who had recently tested positive for COVID-19 and were only experiencing mild symptoms. Within seven days of the start of their symptoms, half of them began taking fluvoxamine, while the other half received a placebo.

The researchers looked for a difference in the two groups’ “clinical deterioration,” or how much sicker one of the groups got. If one of the groups got much sicker than the other, this could mean that that group’s intervention (either the fluvoxamine or the placebo) wasn’t working.

Promising Results

In other words, the researchers wanted to find out if more people’s COVID-19 symptoms got worse on the placebo than on the fluvoxamine. And if they did worse, was the difference “statistically significant,” meaning, did it happen by chance or because the fluvoxamine might have helped.

Though the study was small, the results were promising. None of the people taking fluvoxamine got sicker, but 8.3% of the people in the placebo group did. And several of those who got sicker had to be hospitalized; one was put on a ventilator and, fortunately, survived. The statistical analysis showed a greater than 99% chance that this difference was due to fluvoxamine.

What Next?

But don’t run out and try to get a prescription for fluvoxamine just yet. The researchers cautioned that they need to repeat the study with many more people. If the results with a much larger group come back the same, it would be a boon for battling COVID. The discovery of a drug like this, especially one as cheap and readily available as fluvoxamine, could keep vast numbers of people with mild symptoms out of the hospital, freeing up resources that are stretched to the breaking point right now.

While this discovery may not be a cure-all, it is a good reminder of the progress scientists are making. The top scientists in America are working hard on all kinds of treatments, including the all-important vaccines that will hopefully be available within the coming weeks and months. With some more research, fluvoxamine may help fight the battle as well. As we ride the third wave now, all we need to do is stay hopeful, socially distance, and, please, wear a mask.

Resources

[1] Luvox was first manufactured and marketed by Solvay Pharmaceuticals but is now manufactured and marketed by Jazz Pharmaceuticals.

[2] Prozac is a registered trademark of Eli Lilly and Company.

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is in section Key findings, paragraph 2]

Fluvoxamine (Luvox) | NAMI: National Alliance on Mental Illness. (2016, January). Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Fluvoxamine-(Luvox) on 11/19/20. [Citation is on What Is Fluvoxamine And What Does It Treat?]

Researchers Discover How COVID-19 May Trigger Fatal Levels of Lung Inflammation.  (2020). Retrieved from http://www.bumc.bu.edu/busm/2020/09/21/researchers-discover-how-covid-19-may-trigger-fatal-levels-of-lung-inflammation on 11/19/20.  [Citation is in paragraph 2]

Galiatsatos, P. (2020). What Coronavirus Does to the Lungs. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs on 11/21/20. [Citation is in section COVID-19 Pneumonia]

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is on section Introduction, paragraph 2]

Rosen, D. A., Seki, S. M., Fernández-Castañeda, A., Beiter, R. M., Eccles, J. D., Woodfolk, J. A., & Gaultier, A. (2019). Modulation of the Sigma-1 Receptor-IRE1 pathway is beneficial in preclinical models of inflammation and sepsis. Sci. Transl. Med., 11(478). [Citation is in Introduction, paragraph 3]

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is on section Intervention]

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is on section Primary and Secondary Endpoints]

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is on section Efficacy of Fluvoxamine vs Placebo]

Eric J. Lenze, M. D. (2020). Fluvoxamine vs Placebo and Clinical Deterioration in Outpatients With Symptomatic COVID-19: A Randomized. JAMA. [Citation is on section Discussion]

Hunt, K. (2020, November 21). Coronavirus vaccines: Your questions answered. CNN. Retrieved from https://www.cnn.com/2020/11/16/health/vaccines-coronavirus-covid-19-questions-answered-wellness/index.html on 11/21/20. [Citation is in paragraph 2]

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