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The rise of Omicron, the most recent worrying SARS-CoV-2 variant, is a reminder of how rapidly issues can change through the pandemic.
It was only some weeks in the past that we heard about plenty of potential new antiviral medication and antibody therapies for COVID-19. Researchers are actually asking whether or not such medication will nonetheless be efficient in treating Omicron with its quite a few new mutations. We'll hear extra about this within the coming weeks.
There is proof that some COVID-19 antibody medication in opposition to Omicron could not work as nicely and should must be modified, with Regeneron reporting that preliminary checks recommend its remedy is turning into much less efficient https://t.co/puh48CLvJ8
- Anthony DeRosa (@Anthony) November 30, 2021
However, one other strategy to treating COVID is to "treat the host". Instead of combating the virus by itself, the physique's overwhelming response to the virus must be handled. This strategy is much less liable to new virus variants.
And to try this, we have made some progress with an at first look unlikely group of medicine to deal with COVID-19 - antidepressants. These embrace fluoxetine (e.g. Prozac) and the associated drug fluvoxamine (e.g. Luvox). It's simply starting. But this is what we all know to date.
How may antidepressants deal with COVID?
The antidepressants studied are SSRIs or selective serotonin reuptake inhibitors. These regularly prescribed mood-altering medication block the "re-uptake" of the naturally occurring chemical messenger serotonin by nerve cells within the mind; some antidepressants forestall the breakdown of serotonin. These mechanisms make extra serotonin obtainable to relay messages between neighboring nerve cells.
There are two methods SSRIs can affect COVID-19.
First, human biology is economical
Biological “thrift” determines the framework. It takes lots of effort for the physique to make a single necessary molecule, and an enormous enterprise for those who want a whole lot of them. So biology directs necessary molecules to multitasking.
For instance, all of us make serotonin by making some modifications to the chemical construction of the important amino acid tryptophan, which is usually present in meals.
Serotonin then has the duty:
- a messenger within the mind
- a molecule that causes the intestines to contract
- a platelet coagulation inducer and
- a modulator of how blood vessels work, together with how they slender and the way they work together with the immune system.
The virus chargeable for COVID-19 results in devastating hyperinflammation in extreme sicknesses. This impacts most of the techniques that serotonin is tightly regulated - irritation, platelet clotting, and the right functioning of blood vessels.
So there's a attainable hyperlink between medication that have an effect on serotonin and COVID-19.
Second, medication can open numerous locks
Medicines usually act as "keys" to open sure locks within the physique. However, in some instances the "key" shouldn't be that particular and should shock us by opening further, unrelated locks.
This is named the pleiotropic response and is the premise for utilizing current medication for brand new functions (re-use).
This may clarify why a mood-altering drug could be efficient for extreme infections. As we'll see later, it may open the lock to have an effect on irritation.
Have individuals tried SSRIs for COVID?
There have been plenty of medical research which have proven favorable COVID-19 outcomes for individuals taking SSRIs.
In one preparatory study, Outpatients with COVID-19 signs who had been handled with fluvoxamine had been much less more likely to worsen inside 15 days than those that took the placebo.
Another study discovered that sufferers hospitalized for COVID-19 who had been taking antidepressants - together with the SSRI fluoxetine, and non-SSRI antidepressants - inside 48 hours of admission had been much less more likely to be intubated or die than those that didn't Taking antidepressants.
The newest proof comes from a great independent study Published on-line on the finish of October. It discovered that folks recognized with COVID-19 and taking fluvoxamine decreased their probability of signs getting worse or hospitalized in comparison with these taking the placebo.
Although few research have in contrast fluvoxamine straight with fluoxetine for the remedy of COVID-19, a lot of the best-quality proof so far suggests it Fluvoxamine can have the best promise.
However, there are a variety of research on the broader results of different SSRIs, together with fluoxetine.
What may occur?
It is probably going that our frugal biology is at work, notably the affect of serotonin on platelets and clotting.
SSRIs can scale back the frequency or measurement of blood clots, coronary heart assaults, and strokes that we might usually see in extreme COVID-19.
SSRIs may additionally change anti-inflammatory pathways within the physique, no matter serotonin results. Different SSRIs have totally different talents to do that, which may clarify why some SSRIs seem to have a higher impact on COVID-19 than others.
For instance, Fluvoxamine is a stronger key to unlocking the sigma-1 receptor, which performs an necessary position in controlling irritation. Fluvoxamine may improve melatonin, which is anti-inflammatory.
What else we need to discover out
Despite promising medical research, particularly for fluvoxamine, researchers nonetheless need to know:
- is that a class impact? In different phrases, would all SSRIs work? Although fluvoxamine is extensively used, it isn't available on the market World Health Organization Essential Medicines Listwhereas fluoxetine is. So we have to know whether or not these medication are interchangeable throughout the class of SSRIs and even with antidepressants in a broader sense
- We nonetheless do not know the precise mechanism by which these medication appear to work. But how way more information would we'd like earlier than we may deal with these sufferers within the hospital?
- Could fluvoxamine work in individuals who have been vaccinated? Or is the potential primarily for individuals who usually are not vaccinated and usually tend to have severe sicknesses?
- We want extra data on the attainable unwanted side effects of utilizing SSRIs in COVID-19 sufferers, particularly when utilizing doses apart from the usual dose of antidepressants. However, since SSRIs are current and generally used medication, we already know loads about their results within the physique and attainable unwanted side effects.
However, based mostly on the outcomes to date, specifically with fluvoxamine, we contemplate it essential so as to add it to the record of COVID-19 candidate medication for additional testing and analysis.
Omicron is probably not the final variant of concern. And by “treating the host” with current medication - SSRIs are only one instance - we are able to provide sufferers choices that aren't on the mercy of future, unknown variants.
SSRIs could be harmful if utilized in too excessive a dose for a specific particular person. These medication ought to solely be prescribed by your physician. The medication even have plenty of potential interactions with others that will improve your threat of Serotonin Syndromethat may be life-threatening.
This article was republished by The conversation underneath a Creative Commons license. learn this original article.
Quote: Can Prozac Treat COVID? Maybe, however a associated drug could be higher (2021, December ninth), accessed December ninth, 2021 from https://medicalxpress.com/information/2021-12-prozac-covid-drug.html
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