Longitudinal analysis and treatment of neuropsychiatric symptoms in post-acute sequelae of COVID-19, 2023, Liu et al

2023 study
https://link.springer.com/article/10.1007/s00415-023-11885-x
Paywall

Jennifer H. Yang, Lucas Patel, Jasmine Arora, Amanda Gooding, Ronald Ellis & Jennifer S. Graves
San Diego team, University of California

Abstract
Background
Persistent neuropsychiatric symptoms following acute COVID-19 infection are frequently reported. These include anxiety, depression, difficulty concentrating, fatigue, and insomnia. The longitudinal evolution of this neuropsychiatric burden is poorly understood and clinical guidelines concerning treatment are lacking.

Objective
We sought to describe the longitudinal evolution of neuropsychiatric symptoms in the post-acute sequelae of COVID-19 (PASC) syndrome and examine symptom treatment at a single center.

Methods
Consecutive participants experiencing persistent neurologic symptoms after acute COVID-19 infection were recruited from October 2020 to July 2022. Data collected included COVID-19 infection history, neurological exam and review of systems, Montreal Cognitive Assessment (MoCA), and self-reported surveys concerning neuropsychiatric symptoms and treatment. Data were collected at baseline and at 1-year follow-up.

Results
A total of 106 participants (mean age 48.6, females 67%) were included in the study. At 1-year follow-up, 72.5% of participants reported at least one neuropsychiatric symptom. Over half (52.5%) of participants reported persistent fatigue. At baseline, 38.8% of all participants had met the established MoCA cut-off score of < 26 for mild cognitive impairment; this decreased to 20.0% at 1 year. COVID-19 infection severity was associated with neuro-PASC symptoms (including fatigue and anxiety) at 1 year. Overall, 29% of participants started at least one new medication for COVID-19-associated neuropsychiatric symptoms. Of the participants who started new medications, fatigue was the most common indication (44.8%) followed by insomnia (27.6%).

Conclusions
Neuropsychiatric symptoms related to neuro-PASC improve over time but can persist for over a year post-recovery. Most treatment modalities targeted neuro-PASC fatigue.

 

I posted it because it was cited by another study as suggesting that amantidine (an anti-viral) is the most prescribed medicine for post-Covid-19 fatigue, but the abstract doesn't tell us anything about that.
Mechanisms and treatment progress of neurological diseases of COVID and L-C19 in children, 2025, Li et al

In this Liu et al paper there might be some discussion of other medications tried, although the study is a bit old now. Perhaps this team has done later studies.

 

Thanks @Nightsong.

So, out of 100 participants evaluated for 'PASC treatment exposures', only 29 started treatment for 'neuropsychiatric symptoms' (which includes fatigue).

It's not clear if, in that second quote in Nightsong's post, 'the participants who started new medications' is the same as the 29, or if it is a bigger group who started treatment for any PASC symptom, not just neuropsychiatric. I suspect they are just talking about the 29, given the title of the paper.

If so, 44.8% of the 29 started their new treatment because of the symptom of fatigue. That's 13 people. Of the 13 people, 53.8% of the prescriptions were for amantidine. That's 7 people. 7 out of 100 people evaluated.

Therefore, I think the suggestion in the Chinese review that cites this paper as saying that amantidine is the most prescribed medicine for PASC fatigue is an example of how something reported in a very small number of people can be exaggerated when it is cited.

And that could be a problem. In the case of Amantadine, this CFS study found that people taking it had a lot of side effects and it didn't help.Amantadine and L-carnitine treatment of Chronic Fatigue Syndrome, 1997, Plioplys et al