Treatment of 95 post-Covid patients with SSRIs Rus, Carla P.; de Vries, Bert E. K.; de Vries, Ingmar E. J.; Nutma, Idelette; Kooij, J. J. Sandra After Covid-19 infection, 12.5% develops post-Covid-syndrome (PCS). Symptoms indicate numerous affected organ systems. After a year, chronic fatigue, dysautonomia and neurological and neuropsychiatric complaints predominate. In this study, 95 PCS patients were treated with selective serotonin reuptake inhibitors (SSRIs). This study used an exploratory questionnaire and found that two-thirds of patients had a reasonably good to strong response on SSRIs, over a quarter of patients had moderate response, while 10% reported no response. Overall, patients experienced substantial improved well-being. Brainfog and sensory overload decreased most, followed by chronic fatigue and dysautonomia. Outcomes were measured with three different measures that correlated strongly with each other. The response to SSRIs in PCS conditions was explained by seven possible neurobiological mechanisms based on recent literature on PCS integrated with already existing knowledge. Important for understanding these mechanisms is the underlying biochemical interaction between various neurotransmitter systems and parts of the immune system, and their dysregulation in PCS. The main link appears to be with the metabolic kynurenine pathway (KP) which interacts extensively with the immune system. The KP uses the same precursor as serotonin: tryptophan. The KP is overactive in PCS which maintains inflammation and which causes a lack of tryptophan. Finally, potential avenues for future research to advance this line of clinical research are discussed. Link | PDF (Nature Scientific Reports)
No. They state in limitations — It's probably worth quoting further given that this is an unblinded study with subjective outcomes. The authors try to work with what they had, though I'm sure we will all agree that this does not represent good quality evidence in comparison to an actual DBRPCT.
I guess we'll get a real answer to this one in a couple years when the Brazilian Fluvoxamine study reports out (1500 patients in control / Fluvoxamine / Metformin, though I'm not sure 60 (+30 & 90) day FSS improvement is a great outcome).
So, not controlled or randomized, and retrospective. How does this even get approved and published? Medicine has to rein in the mass of low quality studies, this is not the way to do this. And their weird framing of this being a placebo only reinforces the fact that for the most part, the "placebo" is just what goes on when you do a poor study and have biased and inaccurate results.
Given the study was carried out by online recruitment and the patient's GP prescriblng the medication and questionnaire being submitted online, and lots of the before questionnaires being filled in retrospectively, and Bell scores only showing small levels of improvement which could equally well be explained by patients pacing better and hopium, I can't take this study seriously. It's not a clinical trial in the normal sense as far as I can see. If it were carried out in exactly the same way and the treatment was homeopathy or GET by app, or drinking pumpkin juice while standing on your head, we would not take such results seriously, so I don't think we should with this study.
Sadly , from online groupsI know of a few teens who improved on ssri s . Seemed to be mainly males and some time ago. It was if course taken as proof that low mood was a driver not a consequence.
My PCP put me on SSRI’s to help my LC even though my mood was fine and I was feeling as mentally good as you can given the circumstances. My symptoms worsened, she kept on dismissing it until testing showed I developed serotinin syndrome. Only time will tell but i think that permanently worsened me, and I was already very severe.
My sister was prescribed an SSRI before she was diagnosed with Hashimoto She soon stopped taking the SSRI because she felt terrible on it. When she took the right the meds to treat Hashimoto she felt fine again.
Hi @yannlk, I'm really sorry to hear that. I think this shows up the importance of trials like the one on this thread being done properly with protocols, ethics approvals, expert oversight and watching for side effects etc. SSRI's might be commonly handed out by GP's but they can cause harm, especially probably when used off label and not for the main indication of depression.
I honestly don’t understand why researchers are so obsessed with SSRI’s in LC (and ME/CFS), as with GET/CBT if they made a large positive impact we would definitely know by now.
No control group, useless. Double-blind trials of antidepressants typically show huge placebo effects.
It seems to give them the illusion of doing something that they consider harmless, because the harms of SSRIs have been dismissed for decades. Basically it's win-win as long as you simply don't count the losses. For decades it's been argued that even though it only helps a few, it's worth it for those it helps. They just never consider the broader implications, or the harms, or anything really. Few things have contributed to the lazification of medicine, although much of it is mostly a problem of massive mismatch between supply and demand. And of course calling this class of drugs antidepressants, even though in many cases the mechanism of action seems to affect the immune system. It has distorted the whole thing. And mislabeling chronic illness and a whole lot of health issues they don't have a real explanation for as depression, where it makes sense to give antidepressants. If you don't think about it. Classic "yes two wrongs don't make a right but what about many, many wrongs?"
