Dobrodeeva Vera, Abdyrahmanova Aiperi, Astafeva Darya, Smirnova Daria, Cumming Paul, De Sousa Avinash, Davydkin Igor, Yashikhina Anna, Shnayder Natalia, Nasyrova Regina
Institute of Personalized Psychiatry and Neurology, Shared Core Facilities, V.M. Bekhterev National, Medical Research Centre for Psychiatry and Neurology, Saint Petersburg, Russia.
Psychiatr Danub. 2022 Sep;34(Suppl 8):25-30.
Quarantine measures with self-isolation of varying duration have been significant psychosocial stressors in the context of the COVID-19 pandemic. The serotonin selective reuptake inhibitor fluvoxamine has been considered as a prophylaxis against depression in early COVID-19 patients, with additional benefits apparently arising from its antiviral activity. In this narrative review, we draw attention to the body of evidence showing efficacy of fluvoxamine in protecting against depressive disorders in COVID-19 patients, while also attenuating the severity of COVID-19 disease, with a notable reduction in the need for intubation and lower mortality. We consider this potential two-fold action of fluvoxamine in the light of its pharmacogenetic and pharmacological profiles.
Full-text publications in English and Russian in Google Scholar, PubMed, NCBI, Web of Science, and E-Library databases were selected by keywords, solitary and in combination (fluvoxamine, COVID-19, depression, anxiety, antidepressants, adverse reactions) for the period from March 01, 2020 to June 06, 2022. We also analyzed the full-text publications in English and Russian language reporting adverse reactions caused by fluvoxamine use for the period from 2012 to 2022.
The literature search yielded 10 papers reporting on the efficacy fluvoxamine in relieving depressive symptoms in COVID-19 patients, and 3 papers on its effect on medical outcome. The preponderance of data indicated a dual therapeutic action of fluvoxamine, and our further literature investigation was informative about drug-drug interactions and genetic factors moderating the antidepressant efficacy of fluvoxamine.
Patients with COVID-19 seeking psychopharmacological treatment for depressive symptoms must be informed of the benefits and risks of fluvoxamine use. Several lines of findings indicate this agent to possess an additional antiviral action. However, optimal dosage regimens and the trade-off with drug-drug interactions remain unclear. Pharmacogenetic testing may assist in evidence-based optimization of fluvoxamine dosages in the context of COVID-19 infection with comorbid depression.
在新冠疫情背景下，不同时长的自我隔离检疫措施一直是重大的社会心理压力源。血清素选择性再摄取抑制剂氟伏沙明被视为新冠早期患者抑郁症的预防药物，其抗病毒活性显然还带来了额外益处。在这篇叙述性综述中，我们提请注意一系列证据，这些证据表明氟伏沙明在预防新冠患者抑郁障碍方面具有疗效，同时还能减轻新冠疾病的严重程度，显著减少插管需求并降低死亡率。我们根据其药物遗传学和药理学特征来考量氟伏沙明这种潜在的双重作用。
通过关键词单独及组合（氟伏沙明、新冠病毒、抑郁症、焦虑症、抗抑郁药、不良反应）在谷歌学术、PubMed、NCBI、科学网和电子图书馆数据库中筛选2020年3月1日至2022年6月6日期间的英文和俄文全文出版物。我们还分析了2012年至2022年期间英文和俄文报道的氟伏沙明使用引起的不良反应的全文出版物。
文献检索得到10篇报道氟伏沙明缓解新冠患者抑郁症状疗效的论文，以及3篇关于其对医疗结局影响的论文。大量数据表明氟伏沙明具有双重治疗作用，我们进一步的文献研究提供了有关药物相互作用和调节氟伏沙明抗抑郁疗效的遗传因素的信息。
寻求针对抑郁症状进行精神药理学治疗的新冠患者必须了解使用氟伏沙明的益处和风险。多项研究结果表明该药物具有额外的抗病毒作用。然而，最佳给药方案以及与药物相互作用的权衡仍不明确。药物遗传学检测可能有助于在合并抑郁症的新冠感染背景下基于证据优化氟伏沙明剂量。
