Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2

DOI record: { "DOI": "10.1038/s41398-022-02109-3", "ISSN": [ "2158-3188" ], "URL": "http://dx.doi.org/10.1038/s41398-022-02109-3", "abstract": "<jats:title>Abstract</jats:title><jats:p>Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associated with reduced emergency department (ED) or hospital visits among ambulatory patients with SARS-CoV-2 infection. This retrospective cohort study included adult patients (<jats:italic>N</jats:italic> = 25 034) with a positive SARS-CoV-2 test performed in a non-hospital setting. Logistic regression analyses tested associations between home use of antidepressant medications and a composite outcome of ED visitation or hospital admission within 30 days. Secondary exposures included individual antidepressants and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. Patients with antidepressant exposure were less likely to experience the primary composite outcome compared to patients without antidepressant exposure (adjusted odds ratio [aOR] 0.89, 95% CI 0.79–0.99, <jats:italic>p</jats:italic> = 0.04). This association was only observed with daily doses of at least 20 mg fluoxetine-equivalent (aOR 0.87, 95% CI 0.77–0.99, <jats:italic>p</jats:italic> = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80–1.11, <jats:italic>p</jats:italic> = 0.48). In exploratory secondary analyses, the outcome incidence was also reduced with exposure to selective serotonin reuptake inhibitors (aOR 0.87, 95% CI 0.75–0.99, <jats:italic>p</jats:italic> = 0.04), bupropion (aOR 0.70, 95% CI 0.55–0.90, <jats:italic>p</jats:italic> = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77–0.99, <jats:italic>p</jats:italic> = 0.03). Antidepressant exposure was associated with a reduced incidence of emergency department visitation or hospital admission among SARS-CoV-2 positive patients, in a dose-dependent manner. These data support the FIASMA model of antidepressants’ effects against COVID-19.</jats:p>", "alternative-id": [ "2109" ], "article-number": "341", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "24 March 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Revised", "name": "revised", "order": 2, "value": "8 August 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 3, "value": "9 August 2022" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 4, "value": "22 August 2022" }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 1, "value": "N.H. reported being listed as an inventor on a patent application related to methods of treating COVID-19, filled by Assistance Publique-Hôpitaux de Paris, and he has received consulting fees and nonfinancial support from Lundbeck outside this study. E.J.L. and A.M.R. are co-inventors on a patent application related to methods of treating COVID-19, filed by Washington University in St. Louis. E.J.L. has grant support from Meractus Ventures-Fast Grants (COVID-19 treatment research) and PCORI, and he has done consulting for Boehringer-Ingelheim and Prodeo. No other disclosures were reported." } ], "author": [ { "ORCID": "http://orcid.org/0000-0002-7239-8877", "affiliation": [], "authenticated-orcid": false, "family": "Fritz", "given": "Bradley A.", "sequence": "first" }, { "affiliation": [], "family": "Hoertel", "given": "Nicolas", "sequence": "additional" }, { "affiliation": [], "family": "Lenze", "given": "Eric J.", "sequence": "additional" }, { "affiliation": [], "family": "Jalali", "given": "Farid", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-3203-4590", "affiliation": [], "authenticated-orcid": false, "family": "Reiersen", "given": "Angela M.", "sequence": "additional" } ], "container-title": "Translational Psychiatry", "container-title-short": "Transl Psychiatry", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2022, 8, 22 ] ], "date-time": "2022-08-22T14:04:27Z", "timestamp": 1661177067000 }, "deposited": { "date-parts": [ [ 2022, 8, 22 ] ], "date-time": "2022-08-22T15:06:09Z", "timestamp": 1661180769000 }, "funder": [ { "DOI": "10.13039/100005831", "award": [ "MRTG08152020FRITZ" ], "doi-asserted-by": "publisher", "name": "Foundation for Anesthesia Education and Research" }, { "DOI": "10.13039/100006108", "award": [ "UL1TR002345", "UL1TR002345" ], "doi-asserted-by": "publisher", "name": "U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences" }, { "name": "U.S. Department of Health & Human Services | NIH | National Center for Advancing Translational Sciences" } ], "indexed": { "date-parts": [ [ 2022, 8, 22 ] ], "date-time": "2022-08-22T15:43:28Z", "timestamp": 1661183008128 }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2022, 8, 22 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2022, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 8, 22 ] ], "date-time": "2022-08-22T00:00:00Z", "timestamp": 1661126400000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2022, 8, 22 ] ], "date-time": "2022-08-22T00:00:00Z", "timestamp": 1661126400000 } } ], "link": [ { "URL": "https://www.nature.com/articles/s41398-022-02109-3.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41398-022-02109-3", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41398-022-02109-3.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1038", "published": { "date-parts": [ [ 2022, 8, 22 ] ] }, "published-online": { "date-parts": [ [ 2022, 8, 22 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "DOI": "10.1038/s41591-020-1001-6", "author": "N Hoertel", "doi-asserted-by": "publisher", "first-page": "1417", "journal-title": "Nat Med", "key": "2109_CR1", "unstructured": "Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, et al. 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