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0 0.5 1 1.5 2+ Hospitalization/ER, fluv.. 19% Improvement Relative Risk Hospitalization/ER, FIA.. 12% Hospitalization/ER, SSRI 12% Hospitalization/ER, all an.. 10% Fluvoxamine for COVID-19  Fritz et al.  Prophylaxis Is prophylaxis with fluvoxamine beneficial for COVID-19? Retrospective 25,034 patients in the USA (March 2020 - May 2021) Study underpowed for fluvoxamine, only 17 patients c19early.org Fritz et al., Translational Psychiatry, Aug 2022 Favors fluvoxamine Favors control

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

Fritz et al., Translational Psychiatry, doi:10.1038/s41398-022-02109-3
Aug 2022  
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26th treatment shown to reduce risk in November 2021
 
*, now known with p = 0.00014 from 21 studies, recognized in 3 countries.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,100+ studies for 60+ treatments. c19early.org
Retrospective 25,034 COVID+ outpatients showing significantly lower ER/hospitalization with antidepressants and FIASMA antidepressants, and a dose-dependent response.
risk of hospitalization/ER, 19.4% lower, RR 0.81, p = 0.69, treatment 4 of 17 (23.5%), control 1,896 of 20,457 (9.3%), adjusted per study, odds ratio converted to relative risk, fluvoxamine, multivariable.
risk of hospitalization/ER, 11.9% lower, RR 0.88, p = 0.03, treatment 707 of 3,414 (20.7%), control 1,896 of 20,457 (9.3%), adjusted per study, odds ratio converted to relative risk, FIASMA, multivariable.
risk of hospitalization/ER, 11.9% lower, RR 0.88, p = 0.04, treatment 559 of 2,744 (20.4%), control 1,896 of 20,457 (9.3%), adjusted per study, odds ratio converted to relative risk, SSRI, multivariable.
risk of hospitalization/ER, 10.1% lower, RR 0.90, p = 0.04, treatment 971 of 4,577 (21.2%), control 1,896 of 20,457 (9.3%), adjusted per study, odds ratio converted to relative risk, all antidepressants, multivariable.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fritz et al., 22 Aug 2022, retrospective, USA, peer-reviewed, 5 authors, study period 1 March, 2020 - 16 May, 2021. Contact: bafritz@wustl.edu.
This PaperFluvoxamineAll
Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2
Bradley A Fritz, Nicolas Hoertel, Eric J Lenze, Farid Jalali, Angela M Reiersen
Translational Psychiatry, doi:10.1038/s41398-022-02109-3
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 (N = 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, p = 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, p = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80-1.11, p = 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, p = 0.04), bupropion (aOR 0.70, 95% CI 0.55-0.90, p = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77-0.99, p = 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.
AUTHOR CONTRIBUTIONS Dr. Fritz had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Fritz, Lenze, Reiersen. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: Fritz. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Fritz. Administrative, technical, or material support: Lenze, Reiersen. COMPETING INTERESTS ADDITIONAL INFORMATION Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41398-022-02109-3. Correspondence and requests for materials should be addressed to Bradley A. Fritz. Reprints and permission information is available at http://www.nature.com/ reprints Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Possible involvement of sigma-1 receptors in the ' 'anti-immobility action of bupropion, a dopamine reuptake inhibitor. ' 'Fundam Clin Pharm. 2008;22:387–94.', 'volume': '22', 'year': '2008'}, { 'DOI': '10.1016/j.neuropharm.2016.09.021', 'author': 'A Pandhare', 'doi-asserted-by': 'publisher', 'first-page': '89', 'journal-title': 'Neuropharmacology', 'key': '2109_CR55', 'unstructured': 'Pandhare A, Pappu AS, Wilms H, Blanton MP, Jansen M. The antidepressant ' 'bupropion is a negative allosteric modulator of serotonin type 3A ' 'receptors. Neuropharmacology 2017;113:89–99.', 'volume': '113', 'year': '2017'}, { 'DOI': '10.1016/j.lfs.2004.03.029', 'author': 'B Kopczyńska', 'doi-asserted-by': 'publisher', 'first-page': '2281', 'journal-title': 'Life Sci', 'key': '2109_CR56', 'unstructured': 'Kopczyńska B, Szereda-Przestaszewska M. 5HT2 and 5HT3 receptors’ ' 'contribution to modeling of post-serotonin respiratory pattern in cats. 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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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