Common antidepressant may help adults with long COVID: study

A recently released study suggests that fluvoxamine, a low‑cost and widely available antidepressant, “significantly improved fatigue and quality of life among adults with long COVID.”

The study was co‑led by researchers at McMaster University, alongside those in Brazil and the United States, conducting a clinical trial with 399 adults with fatigue persisting 90 or more days after confirmed SARS-CoV-2 infection.

In a press release, Edward Mills, co‑principal investigator of the trial and professor in McMaster’s department of health research methods, evidence, and impact, said that the research “is an important step forward for patients who have been desperate for evidence‑based options.”

“Fluvoxamine showed consistent and meaningful benefits, and because it’s already widely used and well understood, it has clear potential for clinical use.”

The 60-day clinical trial showed a 99 per cent probability that fluvoxamine outperformed the placebo for “reducing fatigue severity and improving quality of life in people with long COVID.”

Roger McIntyre, a psychiatry, pharmacology and toxicology professor at the University of Toronto, said that the findings from the study provide “a landscape sketch of what long COVID or post-COVID condition actually is.”

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McIntyre also said that the reason why fluvoxamine is being used in this area is because “it targets the immune inflammatory system.”

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“Fluvoxamine is an anti-inflammatory drug along with being an antidepressant, and its anti-inflammatory properties are why it has been used in this regard,” he said.

“They have shown an improvement in fatigue, which seems to suggest that the fluvoxamine, perhaps through its effects on the inflammatory system, is reducing inflammation, and patients are reporting less fatigue, just like you would have less fatigue if you resolved your common cold,” he said.

A November 2022 National Institutes of Health research article states that “fluvoxamine reduced both the risk of death and the need for intensive care in acutely symptomatic COVID-19 patients,” as well as reducing immune responses and alleviating tissue damage.

However, Raymond Lam, a psychiatrist and department of psychiatry professor at the University of British Columbia, believes that more research is needed to decipher the difference between long COVID and depression. 

“Depression is often a symptom of long COVID. People have this terrible fatigue and they get depressed,” he said. “What’s not clear is whether the fluvoxamine is just treating depression or depressive symptoms because fatigue is also a symptom of depression.”

According to Health Canada, fluvoxamine “belongs to a group of medicines called selective serotonin reuptake inhibitors (SSRIs).”

“Fluvoxamine is thought to work by increasing the levels of a chemical in the brain called serotonin (5-hydroxytryptamine).”

It is most commonly used to treat depression, bulimia and obsessive-compulsive disorder. An average daily dosage ranges from 20 mg to 60 mg, depending on a doctor’s prescription.

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In relation to treating long COVID, McIntrye says he “doesn’t anticipate” a future supply and demand issue.

“I don’t think that the world of medicine at this point is going to rapidly adopt this medicine because it has to be replicated. This is a first finding. And in medicine, we like to see replication before we make strong recommendations to start implementing it,” he said.

Lam also noted that “we shouldn’t disregard treatments that might be helpful, even if they’re antidepressants or psychiatric drugs, to save fluvoxamine.”  

“We use a lot of medications off label, which means that it’s not officially approved for that purpose by Health Canada. So there’s no reason that people can’t use it.”