Current Evidence of Cannabidiol's Potential as an Anxiolytic Agent

This article will summarize the current knowledge and scientific evidence regarding cannabidiol as a possible pharmacological tool for anxiety disorders. Although the use of this substance in medical practice is gaining momentum, gaps can still be found in the current knowledge regarding its molecular targets, drug-to-drug interactions, efficacy in different populations, adequate dosage, duration of treatment, and correct formulation. Moreover, current evidence is still preliminary, lacking robust, blinded, and placebo-controlled clinical trials in many areas of investigation. After reading this article, readers should have a thorough understanding of the current scientific evidence regarding the use of CBD as an anxiolytic drug. [Psychiatr Ann. 2023;53(6):242–246.]

Trends in the Consumption of Antidepressant Drugs before and during the COVID-19 Pandemic in the Canary Islands, Spain: The Case of the Province of Las Palmas.

The use of antidepressants (ADs) has increased significantly as a result of COVID-19 and its consequences. However, there are some notable differences in the relative levels of use between geographical areas and population groups. The aim of this work is to assess the impact of COVID-19 on the consumption of ADs in the Canary Islands, focusing on the islands of Gran Canaria, Fuerteventura and Lanzarote, by analyzing the trends in prescriptions of ADs during the pandemic period (2020) compared to the pre-pandemic period (2016-2020). Data were extracted from the community pharmacy wholesaler at a population level. Consumption patterns are expressed as the number of defined daily doses per 1000 inhabitant/day. The overall consumption of DIDs was higher in Gran Canaria, mainly in urban areas and the capital. It was similar in both Lanzarote and Fuerteventura, but particularly localized in the capital, which are considered semi-urban areas. Lanzarote and Fuerteventura present the same pattern of prescription ADs use, whereas Gran Canaria is notably different. This finding was also observed in the more consumed active pharmaceutical ingredients, although small inter-island variations in the ranking and percentages were observed. Sertraline and escitalopram are two of the most prescribed N06AB ADs, whereas the most recent N06AX ADs such as venlafaxine, mirtazapine and desvenlafaxine are more commonly prescribed. These differences in prescription ADs can be explained by demographical characteristics, population size, the fact of living in an urban area and general medical practice. In this context, the COVID-19 pandemic did not have an impact on the overall trend of the use of ADs between 2016 and 2020 in the islands under study.

Identifying knowledge gaps in understanding the effects of selective serotonin reuptake inhibitors (SSRIs) on fish behaviour.

Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressants increasingly prescribed to treat patients with clinical depression. As a result of the significant negative impact of the COVID-19 pandemic on the population's mental health, its consumption is expected to increase even more. The high consumption of these substances leads to their environmental dissemination, with evidence of their ability to compromise molecular, biochemical, physiological, and behavioural endpoints in non-target organisms. This study aimed to provide a critical review of the current knowledge regarding the effects of SSRI antidepressants on fish ecologically relevant behaviours and personality-dependent traits. A literature review shows limited data concerning the impact of fish personality on their responses to contaminants and how such responses could be influenced by SSRIs. This lack of information may be attributable to a lack of widely adopted standardized protocols for evaluating behavioural responses in fish. The existing studies examining the effects of SSRIs across various biological levels overlook the intra-specific variations in behaviour and physiology associated with different personality patterns or coping styles. Consequently, some effects may remain undetected, such as variations in coping styles and the capacity to handle environmental stressors. This oversight could potentially result in long-term effects with ecological implications. Data support the need for more studies to understand the impact of SSRIs on personality-dependent traits and how they may impair fitness-related behaviours. Given the considerable cross-species similarity in the personality dimensions, the collected data may allow new insights into the correlation between personality and animal fitness.

A Cautionary Tale of Antidepressant in the COVID-19 Era: A Case Report of Vortioxetine-Induced Catatonia

During the coronavirus (COVID-19) pandemic, antidepressant prescriptions increased by 18.6%, clearly leading to proportionally increased chances of side effects due to medication exposure. Catatonia is a complex and heterogeneous neuropsychiatric syndrome manifesting up to 40 different signs and symptoms that were categorized into 4 groups, including pure motor, volition disturbance, disinhibited complex motor activities, and autonomic instability. The prevalence of catatonia ranges from 7.6% to 38% in patients presenting with acute psychiatric symptomatology. Though most often associated with psychiatric disorders, it is critical to rule out other medical etiologies. The literature reveals catatonia may manifest in several medical conditions and medications have been implicated in the pathophysiology of catatonia. We present a case of possible vortioxetine-induced catatonia in a patient with a history of schizoaffective disorder bipolar type. [Psychiatr Ann. 2023;53(5):224–227.]

Physical and cognitive correlates, inflammatory levels, and treatment response in post-COVID-19 first-onset vs. recurrent depressive episodes.

Psychiatric symptoms have been frequently reported in patients affected by COVID-19, both as new occurring and recurrences of pre-existing diseases. Depressive symptoms are estimated to affect at least 30% of patients following infection, with specific physical and cognitive features and relevant immune-inflammatory alterations. This study aimed to retrospectively characterize post-COVID-19 first-onset and recurrent major depressive episodes (MDE) and to evaluate the effects of antidepressants on physical and cognitive correlates of depression, in addition to mood, anxiety, and underlying inflammatory status. We evaluated 116 patients (44.8% males, 51.1 ± 17 years) with post-COVID-19 first-onset (38.8%) and recurrent (61.2%) MDE at baseline and after one- and three-month treatment with antidepressants (31% SSRIs, 25.9% SNRIs, 43.1% others). We assessed sociodemographic and clinical features and psychopathological dimensions through: Hamilton Depression and Anxiety Rating Scales; Short Form-36 Health Survey Questionnaire; Perceived Deficits Questionnaire-Depression 5-items. The systemic immune-inflammatory index was calculated to measure inflammation levels. Alongside the reduction of depression and anxiety (p < 0.001), physical and cognitive symptoms improved (p < 0.001) and inflammatory levels decreased (p < 0.001) throughout treatment in both groups. Post-COVID-19 recurrent MDE showed a significantly more severe course of physical and cognitive symptoms and persistently higher levels of inflammation than first-onset episodes. Antidepressants proved to be effective in both post-COVID-19 first-onset and recurrent MDE. However, a sustained inflammatory status might blunt treatment response in patients with recurrent depression in terms of physical correlates and cognition. Therefore, personalized approaches, possibly involving combinations with anti-inflammatory compounds, could promote better outcomes in this clinical population.

Controversies around COVID-19 Vaccines and Antidepressants: Scope and Perspective in Malaysia.

BACKGROUND: Individuals with severe mental illness are prone to severe COVID-19 infection with increased morbidity and mortality. Psychiatric patients are often concerned about the potential interactions between the newly approved COVID-19 vaccines in Malaysia and psychotropic drugs like antidepressants. To date, such data are unavailable. OBJECTIVES: This review aims to clear the polemics of COVID-19 vaccine-antidepressants interaction in these 3 aspects: (1) cytokines and cytochrome P450 pathway, (2) blood-brain barrier (BBB) involvement and (3) and its interaction with polyethylene glycol (PEG), the potential allergenic culprit following COVID-19 vaccination. METHODS: A systemic scoping approach was employed to search for peer-reviewed journal articles across four healthcare and scientific databases (PubMed, MEDLINE, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). RESULTS: Antidepressants metabolism often involve the CYP450 enzymes. Vaccine-antidepressants interactions are probable, likely to be triggered by interactions of CYP450 enzymes and inflammatory cytokines, resulting in diminished drug metabolism and chemical detoxification. Aside, PEG, the excipient in mRNA-based COVID-19 vaccines and antidepressants, has been reported as the anaphylaxis causative allergen. However, whether it leads to a synergistic, potentiation or antagonistic effects when used in combination, remains to be elucidated. CONCLUSION: Psychotropic medications, including antidepressants, showed potentially relevant safety risk for COVID-19 patients. These vulnerable patient group must be prioritized for early access to safe and efficacious COVID-19 vaccines, as vaccination remains the most important public health intervention to tackle the ongoing COVID-19 pandemic.

The risks of adverse events with venlafaxine and mirtazapine versus 'active placebo', placebo, or no intervention for adults with major depressive disorder: a protocol for two separate systematic reviews with meta-analysis and Trial Sequential Analysis.

BACKGROUND: Major depressive disorder causes a great burden on patients and societies. Venlafaxine and mirtazapine are commonly prescribed as second-line treatment for patients with major depressive disorder worldwide. Previous systematic reviews have concluded that venlafaxine and mirtazapine reduce depressive symptoms, but the effects seem small and may not be important to the average patient. Moreover, previous reviews have not systematically assessed the occurrence of adverse events. Therefore, we aim to investigate the risks of adverse events with venlafaxine or mirtazapine versus 'active placebo', placebo, or no intervention for adults with major depressive disorder in two separate systematic reviews. METHODS: This is a protocol for two systematic reviews with meta-analysis and Trial Sequential Analysis. The assessments of the effects of venlafaxine or mirtazapine will be reported in two separate reviews. The protocol is reported as recommended by Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols, risk of bias will be assessed with the Cochrane risk-of-bias tool version 2, clinical significance will be assessed using our eight-step procedure, and the certainty of the evidence will be assessed with the Grading of Recommendations Assessment, Development and Evaluation approach. We will search for published and unpublished trials in major medical databases and trial registers. Two review authors will independently screen the results from the literature searches, extract data, and assess risk of bias. We will include published or unpublished randomised clinical trial comparing venlafaxine or mirtazapine with 'active placebo', placebo, or no intervention for adults with major depressive disorder. The primary outcomes will be suicides or suicide attempts, serious adverse events, and non-serious adverse events. Exploratory outcomes will include depressive symptoms, quality of life, and individual adverse events. If feasible, we will assess the intervention effects using random-effects and fixed-effect meta-analyses. DISCUSSION: Venlafaxine and mirtazapine are frequently used as second-line treatment of major depressive disorder worldwide. There is a need for a thorough systematic review to provide the necessary background for weighing the benefits against the harms. This review will ultimately inform best practice in the treatment of major depressive disorder. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022315395.

Repurposing selective serotonin reuptake inhibitors for severity of COVID-19: A population-based study.

The World Health Organization has proposed that a search be made for alternatives to vaccines for the prevention and treatment of COVID-19, with one such alternative being selective serotonin reuptake inhibitors (SSRIs). This study thus sought to assess: the impact of previous treatment with SSRI antidepressants on the severity of COVID-19 (risk of hospitalisation, admission to an intensive care unit [ICU], and mortality), its influence on susceptibility to SARS-CoV-2 and progression to severe COVID-19. We conducted a population-based multiple case-control study in a region in the north-west of Spain. Data were sourced from electronic health records. Adjusted odds ratios (aORs) and 95%CIs were calculated using multilevel logistic regression. We collected data from a total of 86,602 subjects: 3060 cases PCR+, 26,757 non-hospitalised cases PCR+ and 56,785 controls (without PCR+). Citalopram displayed a statistically significant decrease in the risk of hospitalisation (aOR=0.70; 95% CI 0.49-0.99, p = 0.049) and progression to severe COVID-19 (aOR=0.64; 95% CI 0.43-0.96, p = 0.032). Paroxetine was associated with a statistically significant decrease in risk of mortality (aOR=0.34; 95% CI 0.12 - 0.94, p = 0.039). No class effect was observed for SSRIs overall, nor was any other effect found for the remaining SSRIs. The results of this large-scale, real-world data study indicate that, citalopram, could be a candidate drug for being repurposed as preventive treatment aimed at reducing COVID-19 patients' risk of progressing to severe stages of the disease.

Analysis of the impact of the COVID-19 pandemic on psychotropic drug use

Background and ImportanceThe COVID-19 disease, declared a pandemic in March 2020, radically changed people's way of life. The health risk, the measures of the state of alarm and its impact at social and economic level have exposed the population to a threat to their psychological well-being.Aim and ObjectivesTo analyse the relationship between COVID-19 and changes in the trend of psychotropic drug consumption.Material and MethodsDescriptive drug utilisation study which included 665,222 inhabitants. This population is distributed in an urban (UA) (275,990 inhabitants) and rural, peri-urban (RA) (389,232 inhabitants) area. The study period was January 2018 to December 2021. Data were obtained from the database of dispensed and billed prescriptions. The unit used was the Defined Daily Dose (DDD) and the main variable was the DDD per 1000 inhabitants and day (DHD). The therapeutic groups studied were benzodiazepines (N05BA, N05CA, N05CF) and antidepressants (N06AB, N06AX), according to the Anatomical Therapeutic Chemical Classification System (ATC). Mann–Whitney test was used for statistical analysis.ResultsThe group of drugs with the greatest increase in consumption was benzodiazepines, followed by antidepressants, the latter being higher in the 2nd and 4th quarter of 2020, coinciding with the first and second wave and higher in rural areas. In antipsychotic dispensations, a slight increase was only observed in the metropolitan area (p<0,05). During the year 2021, the rates of benzodiazepines were decreasing, ending the year at values similar to pre-pandemic rates. In contrast, the increase in antidepressant use was sustained during 2021.-DHD 2nd Quarter:BENZODIAZEPINESUA: 2018:86.71;2019: 83.58;2020:86.16;2021:81.71RA:2018:88.97;2019: 88.95;2020:97.63;2021:87.85ANTIDEPRESSANTSUA:2018:38,79;2019:39,73;2020:40,16;2021 41,38RA:2018:44.76;2019:45.58;2020:48.49;2021:47.85-DHD 4th QuarterBENZODIAZEPINESUA: 2018: 84.67;2019: 83.15;2020: 87.60;2021: 82.00RA: 2018: 88.42;2019: 89.97;2020: 97.38;2021: 87.84ANTIDEPRESSANTSUA: 2018: 38.73;2019: 39.72;2020: 40.99;2021: 43.14RA: 2018: 45.12;2019: 46.24;2020: 48.91;2021: 49.19It was only statistically significant the increase in the consumption of antidepressants (P=0.019) in the periods 2020-2021vs 2018-2019.Conclusion and RelevanceThe uncertainty in the first months of the pandemic, bereavement, isolation and the effects of the economic crisis may have favoured an increase in the consumption of antidepressants and benzodiazepines. It would be necessary to reorient clinical practice strategies, promoting the appropriate and safe use of these drugs in the primary and hospital care setting.References and/or AcknowledgementsConflict of InterestNo conflict of interest.

Use of Psychotropics in COVID-19: Another Anti-inflammatory Pathway

The emergence of the novel coronavirus SARS-CoV-2 has significantly impacted the world's population, disrupting healthcare systems around the globe and leading to human and material losses. While different vaccines have been approved in record time, there continues to be a high number of daily new cases, and patients face a wide range of presentations of the disease, from asymptomatic to potentially fatal. Therefore, the search for therapeutic agents that can aid in the management and control of the disease has become one of the main goals for researchers and clinicians. As an inflammatory disease, targets for the treatment of COVID-19 have largely involved the immune system. Inflammation has also been associated with mental health disorders, and studies have shown the potential involvement of inflammatory pathways in the pathophysiology of depression. As a consequence, the hypothesis of using antidepressants and other psychotropics for the treatment of COVID-19 has emerged. In this review, we aim to summarize the molecular pathways that could be involved as well as the emergent evidence that has been reported by studies performed since the appearance of SARS-CoV-2 in 2019. While it has been observed that there are potential therapeutic pathways for the use of antidepressants in the treatment of COVID-19, additional studies are needed to evaluate the feasibility, safety, and efficacy of psychotropics in this disease.Copyright © 2023 Bentham Science Publishers.

Drug Interactions of Psychiatric and COVID-19 Medications

Introduction:Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics.Methods:Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications.Results:There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce life-threatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system.Conclusion:DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.

Abordaje farmacoterapéutico de la ansiedad desde la oficina de farmacia

El consumo de fármacos indicados en el tratamiento de trastornos del sueño, ansiedad y depresión –benzodiazepinas, análogos Z y antidepresivos– se ha visto duplicado en el año 2020 a raíz de la pandemia mundial COVID-19 frente a 2019. El objetivo principal del trabajo es analizar el perfil del paciente en tratamiento con ansiolíticos/antidepresivos teniendo en cuenta variables como edad, sexo, principio activo y constancia con la medicación. Se diseñó un estudio observacional descriptivo de tipo transversal, en el que la población de estudio consta de pacientes en tratamiento con al menos un fármaco ansiolítico –hipnótico o benzodiacepina–, siendo una muestra total de 80 pacientes. La recogida de datos se realizó durante los meses de marzo a junio en la oficina de farmacia a través de un cuestionario, contestado de forma voluntaria y anónima por los participantes. Para su elaboración se realizó una búsqueda por principio activo/especialidad farmacéutica, a través de las fichas técnicas de los medicamentos. Los cuestionarios fueron analizados en la base de datos Python v3.8.5. Se observó que el consumo de esta clase de fármacos es más común en mujeres y en personas de entre 20-30 años, siendo lorazepam el ansiolítico más dispensado y combinado con antidepresivos.Alternate abstract:The consumption of drugs indicated for the treatment of sleep disorders, anxiety and depression – benzodiazepines, Z analogues and antidepressants – has doubled in 2020 as a result of the global pandemic COVID-19 compared to 2019. The main objective of this study is to analyse the patients' profile treated with anxiolytics/antidepressants, taking into account their ages, sex, drugs taken and perseverance with medication. A cross-sectional descriptive observational study was designed, in which the study population consisted of patients being treated with at least one anxiolytic drug – hypnotic or benzodiazepine – with a total sample of 80 patients. Data collection was carried out from March to June at the chemist's by means of a questionnaire, answered voluntarily and anonymously by patients. A search by active ingredient/pharmaceutical speciality was carried out using drug technical sheets. The questionnaires were analysed with Python v3.8.5 database. It was observed that the consumption of this kind of drugs is more common among women, and among 20-30 year-old-people, being lorazepam the most dispensed anxiolytic and combined with antidepressants.

Investigation of anxiety among pharmacy students during the COVID-19 pandemic in Northern Cyprus

Background: Anxiety is common among university students and previous research has highlighted the association between the COVID-19 pandemic and higher anxiety scores in the public. Objectives: In this regard, this study aimed to evaluate the effect of the COVID-19 pandemic on the anxiety status of pharmacy students studying in Northern Cyprus and analyze the role of some parameters on the observed anxiety scores. Methods: Anxiety scores of 185 pharmacy students studying at two universities in Northern Cyprus were evaluated using Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder-7 (GAD-7) assessments. Additionally, the information of participants was recorded in terms of sociodemographic and educational characteristics, antidepressants and anxiolytic use, and consumption of vitamin-mineral supplements. The questionnaires were distributed during the COVID-19 pandemic from December 11, 2020, to January 4, 2021, online via the Microsoft TeamsR platform. It should be mentioned that responses were anonymous. Results: The mean BAI and GAD-7 scores of pharmacy students were 13.1+or-11.2 and 10+or-6.7, respectively. Based on the results, 6% of the students (n=11) revealed potentially concerning levels of anxiety in their BAI responses. Moreover, 31.9% of the pharmacy students (n=59) demonstrated severe anxiety scores on the GAD-7. Positive COVID-19 cases in the family led to statistically significant increases in anxiety on both instruments. Pharmacy students with five years of education (B. Pharm/M. Pharm) showed significantly higher anxiety scores on the BAI. Besides, age correlated negatively with anxiety scores on the GAD-7. Neither antidepressant and anxiolytic use nor vitamin/mineral supplement use were not related to the anxiety scores of participants. Conclusion: Results of this study demonstrated an alarming anxiety status among pharmacy students during the COVID-19 pandemic period. Diagnosis of a family member with COVID-19 was observed to be critical in triggering the anxiety of pharmacy students. Data from this study should raise awareness to take action plans for the mental well-being of pharmacy students during pandemics.

LIFESTYLE PATTERNS ASSOCIATED WITH BURNOUT DIMENSIONS DURING SARS-COV2 PANDEMIC. A WEB-BASED SURVEY OF DENTAL HEALTHCARE WORKERS

Multiple lines of evidence suggest that significant lifestyle changes, including diet, exercise, sleep, stress, job status, recreation, and use of modern technologies may lead to various COVID-19 related health problems in the general population, as well as among healthcare workers [3-8]. The first part contained 21 questions gathering information about dentists' demographic characteristics (e.g., age, gender, marital status), work environmental conditions (e.g., average working hours per day, dental equipment, auxiliary staff, self-assessed income, etc.), dentists' lifestyle patterns (hobbies/ spare time activities, insomnia, and use of antidepressants and sleeping pills), perceptions and attitudes towards the coronavirus pandemic (e.g., sources of stress, vaccination intentions, etc.) and retirement plans. In this group, a very high level of burnout was observed regarding EE (43.13±4.80) and DP (15.13±5.04) dimensions. [...]the high dimension of performance loss was significantly related to the regular use of these medicines (p<0.001) - Table 3. Various studies have shown that the outbreak of SARS-CoV-2 pandemic has profound psychological and social effects, identifying significant lifestyle changes and mental health problems [2,4,11].

Fast-track for timely treatment of depression in college students

Background: Depression is a prevalent and leading issue among college students, which became worsened by the global pandemic of COVID-19. The Student Health Clinic in one of the tertiary public universities in Southern California also proved to be impacted with mental health complaints, depression being one of the most common diagnoses. The early treatment of depression is critical to avoid possible complications including suicidal ideation from untreated depression. Objectives: The primary objective was to implement a new workflow (Fast-Track) to treat students with uncomplicated depression as early as possible. Method: This project used a pre- and post-intervention design. The Fast-Track has three components: 1) reserving appointment slots from primary care providers' clinic schedules for the Fast-Track patients, 2) sending an education material about depression treatment options to the patients to read before an initial visit, 3) providing two follow-up visits at weeks 2, and 5 or 6. A descriptive analysis was performed for demographic data and secondary outcome (PHQ-9 score), Paired two sample t-Test was used for the primary outcome (time to treatment in days). Data from the participants who completed the two follow-up visits were included in the analysis. Results: A total of 24 patients met the criteria for uncomplicated depression. 16 patients completed the two follow-up visits. Time to treatment in days reduced from 19.2 days (SD 4.6) to 2.5 days (SD 1.8) (p < 0.05). The mean PHQ-9 score at the baseline visit was 13.6 (SD 4.1) and 11.4 (SD 2.5) at the second follow-up visit with a mean change of -2. 2. 81.3% (n=13) of the 16 patients reported improvement at week 5 or 6 and 18.6 % (n=3) reported worsening of their depression symptoms. Conclusion: Opening up access to provider schedules greatly improved the patient's time to treatment. Utilizing primary care providers, including APRN's, in the management of simple, uncomplicated depression for college students was safe and successful. The outcomes seen in this project offer some insight into how the pharmacological treatment for simple, uncomplicated depression can be safely initiated sooner among college students. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Overview of the potential use of fluvoxamine for COVID-19 and long COVID.

Coronavirus disease 2019 (COVID-19) has presented a serious worldwide threat to public health since its emergence in late 2019. From a safety point of view, drug repurposing has received particular attention. Several clinical studies have demonstrated that the use of fluvoxamine, a selective serotonin reuptake inhibitor with potent sigma-1 receptor agonism, in the early-stage of infection might be associated with the prevention of clinical deterioration in individuals with SARS-CoV-2 infection, although several reports have shown that a low dose of fluvoxamine may be ineffective. There is increasing evidence that SARS-CoV-2 can cross the blood-brain barrier, resulting in a number of psychiatric and neurologic symptoms in COVID-19 survivors. Importantly, about half of COVID-19 survivors experience a variety of long-term sequelae, including psychiatric and neurologic symptoms, known as long COVID. In this priority review, the author presents an overview of the potential use of fluvoxamine in the treatment of COVID-19 and long COVID.

Use of psychotropic drugs in the elderly in France: Are we condemned to remain at high tide?

Psychotropics are widely used drugs, especially in the elderly, especially in France. This, and the risks associated to their use, logically led to concerns that resulted in numerous studies, reports, and regulatory actions intending to limit this use. This review objective was to provide an overview of psychotropic use in elderly subjects in France for antipsychotics, antidepressants, and benzodiazepines and related drugs. The narrative review performed is structured in two parts. The first reminds the initial steps of psychotropic use monitoring in the general French population. The second provides information on psychotropic use in elderly in France using the latest open data released by the French Health Insurance system and processed using the dedicated DrugSurv tool developed within the DRUGS-SAFE® and DRUGS-SAFE® programs. This was completed examining the most recent studies regarding psychotropic use in elderly in France, whether they consisted in publications or reports. At least before the COVID-19 epidemic, decreases in psychotropic prevalence of use among the elderly in France could be observed, mostly for antipsychotics or benzodiazepines (e.g. antipsychotics, 2006-2013: 10.3% decrease and benzodiazepines 2012-2020: decrease from 30.6% to 24.7% in subjects aged ≥65). Psychotropic prevalence of use remained however very high overall (e.g. antidepressants, 2013: 13% in subjects aged 65-74 and 18% in aged ≥65), exceeding that of most other countries, with a significant proportion of inappropriate use (e.g. in 30% of benzodiazepine users, all ages) carrying a clearly identified risks for uncertain benefit. Initiatives have been multiplied at the national level to reduce psychotropic overuse in the elderly. The reported prevalences demonstrate their effectiveness is obviously insufficient. This limited effectiveness is not specific to psychotropics and might reside in a failure to create strong adherence to messages and recommendations. Other levels should be considered, especially regional, for interventions coupled with pharmacoepidemiologic monitoring allowing impact assessment.

Sales trends of psychotropic drugs in the COVID-19 pandemic: A national database study in Brazil.

Background: The social restrictions among coronavirus disease 2019 (COVID-19) pandemic have posed a thoughtful risk to mental health and have implications in the use of drugs, including antidepressants, anxiolytics and other psychotropics. Objective: This study analyzed the sales data of the psychotropics prescribed in Brazil, in order to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This interrupted time-series analyzed psychotropic sales data, between January 2014 and July 2021, using the National System of Controlled Products Management from The Brazilian Health Regulatory Agency. The monthly mean DDDs per 1,000 inhabitants per day of psychotropic drugs was evaluated by analysis of variance (ANOVA) followed by Dunnett Multiple Comparisons Test. The changes in monthly trends in the use of the psychotropic studied were evaluated by Joinpoint regression. Results: During the period studied, clonazepam, alprazolam, zolpidem and escitalopram were the most sold psychotropic drugs in Brazil. According to Joinpoint regression, an upward trend was observed in sales during the pandemic of pregabalin, escitalopram, lithium, desvenlafaxine, citalopram, buproprion and amitriptyline. An increase in psychotropic consumption was noted throughout the pandemic period, with the maximum consumption (2.61 DDDs) occurring in April 2021, with a downward trend in consumption that accompanied the drop in the number of deaths. Conclusions: The increase in sales, mainly of antidepressants during the COVID-19 pandemic, draws attention to issues related to the mental health of the Brazilian population and on the need for greater monitoring in the dispensing of these drugs.

Do the lockdown-imposed changes in a wastewater treatment plant catchment's socio-demographics impact longitudinal temporal trends in psychoactive pharmaceutical use?

Wastewater-based epidemiology (WBE) includes the analysis of human metabolic biomarkers of xenobiotics in influent wastewater. WBE complements existing drug utilization approaches and provides objective, spatio-temporal information on the consumption of pharmaceuticals in the general population. This approach was applied to 24-h composite influent wastewater samples from Leuven, Belgium. Daily samples were analysed from September 2019 to December 2019 (n = 76), and on three days of the week (Monday, Wednesday, Saturday) from January 2020 to April 2022 (n = 367). Sample analysis consisted of 96-well solid-phase extraction and liquid chromatography coupled to tandem mass spectrometry. Measured concentrations of 21 biomarkers for antidepressant and opioid use were converted to population-normalized mass loads (PNML) by considering the flow rate and catchment population. To capture population movements, mobile phone data was used. Amitriptyline, hydroxy-bupropion, norcitalopram, citalopram, normirtazapine, trazodone, O-desmethylvenlafaxine, codeine, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), methadone, morphine, O-desmethyltramadol, and tramadol were included in the temporal assessment since concentrations were above the lower limit of quantification. The PNML of most biomarkers increased (with 3-119 %) throughout the sampling period. The population disruption during the COVID-19 pandemic led to a major change in the socio-demographics of the catchment area, resulting in temporal differences in the PNML of the different biomarkers. As such, higher PNML were observed during the different lockdown phases, which were characterized by the outflow of university students and a decreasing commuting in and out the catchment area. The effects of the fluctuating socio-demographics of the catchment population were further evidenced by the different week-weekend pattern of PNMLs over the course of the sampling campaign. Mean parent/metabolite ratios (i.e., citalopram/norcitalopram, tramadol/O-desmethyltramadol, venlafaxine/O-desmethylvenlafaxine, and methadone/EDDP) remained relatively stable throughout the entire sampling campaign (RSD% below 25 % for all ratios, except for methadone/EDDP) and therefore were not affected by this population change.