key: cord-0702574-ja9y4mzi
authors: Bereza, Z.; Micale, V.; Drago, F.; Fedotova, J.
title: P.0403 Disticnt effects of SSRIs therapy in patients with the first episode of major depressive disorder/generalized anxiety disorder after COVID-19 disease
date: 2021-12-30
journal: Eur Neuropsychopharmacol
DOI: 10.1016/j.euroneuro.2021.10.376
sha: d02b904ff08189a79f9283d0f9d105711a96e9aa
doc_id: 702574
cord_uid: ja9y4mzi

nan

P.0403 Disticnt effects of SSRIs therapy in patients with the first episode of major depressive disorder/generalized anxiety disorder after COVID-19 disease Introduction: The World Health Organization postulated Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) is a pandemic situation in the whole world [1] . Although the main damaging of SARS-Cov-2 in the human organism is linked to its severe acute respiratory illness, a new coronavirus, SARS-CoV-2 implicates in the various central nervous system impairments and deteriorations [ 1 , 2 ] . The major clinical outcomes of COVID-19 in the brain are associated with its deleterious neurological and mental health actions [3] . Currently, we do not know exactly how actually SARS-CoV-2 might negatively alter the brain functions in humans.

Today, there are limited findings concerning the studying of neuropsychiatric action for SARS-Cov-2 in humans after COVID-19 disease.

The aim of the present study was to compare the efficacy of SSRIs (escitalopram, sertraline and fluoxetine) for 6 months therapy on the affective profile of man and women with the first Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) cases following COVID-19 disease without any previous psychiatric diagnosis. Methods. For the assessment of affective profile in man and women (30-55 years) with the first MDD or GAD cases after COVID-19 disease, we used the different tests: Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety scale (ShARS Scale). The hormonal and Vitamin D 3 levels in the serum blood were measured by immune-enzyme analysis before and after SSRIs therapy. Results. After 6 months of SSRIs therapy, MADRS Scale showed a significant improvement of the depressive manifestations in both men and women with the first MDD case after COVID-19 (p%26lt;0,05). However, these patients of both gender demonstrated significantly high anxiety level S291 Abstracts by ShARS Scale. We found that SSRIs were able to reduce anxiety level only on 25%25 in man or on 35%25 in women with the first MDD case after COVID-19 before treatment (p%26lt;0,05). Interestingly, MADRS Scale showed a similar improvement of the depressive manifestations in both men and women with the first GAD case after COVID-19 treated with SSRIs for 6 months (p%26lt;0,05). Also, women with the first GAD case after COVID-19 treated with SSRIs had the parameters of their affective profile that were similarly to those of control group. The reduction of depressive symptoms in women with the first GAD case after COVID-19 treated with SSRIs was associated with restoration of cortisol concentrations in the serum blood compared to the initial levels. Conclusion: Thus, our pilot clinical study clearly demonstrated that SSRIs treatment have a beneficial effect on the depressive symptoms in patients of both gender with the first MDD or GAD cases after COVID-19. However, SSRIs therapy alone failed to produce the decrease of anxiety in the patients of both gender with the first MDD or GAD cases after COVID-19. In light of the demonstrated data, the importance of truly adequate treatment to the long-term neuropsychiatric outcomes of COVID-19 in patients of both gender, further randomized clinical trials involving new pharmacological therapies are needed in the future. Introduction: Depression was reported in 30-40% of patients at one, three, and six months following COVID-19 [1] . The host immune response to SARS-CoV-2 infection and related severe systemic inflammation seems to be the main mechanism contributing to the development of post-COVID depression. Emerging literature suggests anti-inflammatory and antiviral properties of antidepressants in the treatment of SARS-CoV-2 infection [2] .

We hypothesized that post-COVID depression, triggered by infection and sustained by systemic inflammation, could particularly benefit from antidepressants. Thus, the present study aims to investigate the efficacy of SSRI in treating post-COVID depression. Methods: We included 58 adults patients who showed depressive episodes in the six months following COVID-19. We excluded patients if they showed: other psychiatric comorbidities, ongoing treatment with antidepressants or neuroleptics, somatic disease and medications known to affect mood. The severity of depression was rated at baseline and after for four weeks from the start of the treatment on the Hamilton Depression Rating Scale (HDRS) and response was considered when the patients achieved a 50% HDRS reduction after treatment.

Statistical analyses to compare group means and frequencies (Student's t-test, Pearson χ 2 test) were performed. To investigate changes in HDRS scores over time, repeated measures ANOVAs (according to sex, mood disorder history, and antidepressant molecule) were performed. Results: We found that 53 (91%) patients showed a clinical response to antidepressant treatment. Age, sex, mood disorder history, and hospitalization for COVID did not affect the response rate.

Patients were treated with sertraline (n = 26), citalopram (n = 18), paroxetine (n = 8), fluvoxamine (n = 4), and fluoxetine (n = 2). From baseline to follow-up, patients showed a significant decrease over time of HDRS score (F = 618.90, p < 0.001), irrespectively of sex (0.28, p = 0.599), mood disorder history (F = 0.04, p = 0.834), and drug used (F = 1.47, p = 0.239). Discussion: Common knowledge highlights that among antidepressant-treated patients, response rates are moderate (40-60%). On the contrary, we observed a rapid response to the first-line antidepressants in more than 90% of patients irrespectively of clinical variables, thus suggesting a higher antidepressant response rate in post-COVID depression.

The pathophysiology of post-COVID neuropsychiatric sequelae mainly entails severe systemic inflammation and subsequent neuroinflammation. In this context, we have previously found that one and three months after COVID-19, the severity of depression was predicted by the baseline systemic immune-inflammation index (SII) [ 3 , 4 ] . Furthermore, we found a protective effect of the IL-1 β and IL-6 receptor antagonist against post-COVID depression possibly associated with their effect in dampening SII [5] .

Mounting evidence suggests that antidepressants may a) decrease markers of inflammation; b) may inhibit acid sphingomyelinase preventing the infection of epithelial cells with SARS-CoV-2; c) may prevent the COVID-19 related cytokine storm by stimulating the σ -1 receptor; d) may exert antiviral effects via lysosomotropic properties; e) may inhibit platelets activation [2] .

In conclusion, we hypothesized that post-COVID depression could particularly benefit from antidepressants since this molecules have anti-inflammatory and antiviral properties, pass the BBB and accumulate in the CNS, thus preventing the neuro-inflammation triggered by SARS-CoV-2 and associated with post-COVID depression.

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