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This study compares the serological antibody level post-COVID-19 vaccine among healthy subjects and psychiatric patients on antidepressant therapy. It also examines the difference in antidepressants' side effects experienced by psychiatric patients following the completion of two vaccine doses. A comparative posttest quasi-experimental study was conducted among healthy subjects and psychiatric patients on antidepressant medication in a teaching hospital in Malaysia. Elecsys Anti-SARS-CoV-2 assay was used to detect the antibody titre between weeks 4 and 12 post vaccination. The antidepressant side-effect checklist (ASEC) was used to monitor the occurrence of antidepressant-related side effects pre-and post-vaccination. 24 psychiatric patients and 26 healthy subjects were included. There was no significant difference in the antibody level between the patients (median = 1509 u/ml) and the healthy subjects (median = 995 u/ml). There was no significant worsening in the antidepressant-related side effects. The antibody level post-COVID-19 vaccine did not differ significantly between patients on antidepressant therapy and healthy subjects. Additionally, there was no change in the antidepressant side effects experienced by the patients following the completion of the vaccine.Copyright © 2022, Research Trends (P) LTD.. All rights reserved.
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Androgen insensitivity syndrome has a wide spectrum of presentations. It results from a mutation in androgen receptor (AR) gene. It ranges from mild androgen insensitivity syndrome (MAIS) which is the mildest form to complete androgen insensitivity syndrome (CAIS). In case of MAIS, the abnormality that can be observed appears to be male infertility and sexual difficulties including premature ejaculation and erectile dysfunction. In this case report, we discuss a case of MAIS in a 37-year-old male who presented with infertility, premature ejaculation, and secondary erectile dysfunction.Copyright © 2023, Ibn Sina Trust. All rights reserved.
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The emerging COVID-19 pandemic led to a dramatic increase in global mortality and morbidity rates. As in most infections, fatal complications of coronavirus affliction are triggered by an untrammeled host inflammatory response. Cytokine storms created by high levels of interleukin and other cytokines elucidate the pathology of severe COVID-19. In this respect, repurposing drugs that are already available and might exhibit anti-inflammatory effects have received significant attention. With the in vitro and clinical investigation of several studies on the effect of antidepressants on COVID-19 prognosis, previous data suggest that selective serotonin reuptake inhibitors (SSRIs) might be the new hope for the early treatment of severely afflicted patients. SSRIs' low cost and availability make them potentially eligible for COVID-19 repurposing. This review summarizes current achievements and literature about the connection between SSRIs administration and COVID-19 prognosis.
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The global spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the continuously emerging new variants underscore an urgent need for effective therapeutics for the treatment of coronavirus disease 2019 (COVID-19). Here, we screened several FDA-approved amphiphilic drugs and determined that sertraline (SRT) exhibits potent antiviral activity against infection of SARS-CoV-2 pseudovirus (PsV) and authentic virus in vitro. It effectively inhibits SARS-CoV-2 spike (S)-mediated cell-cell fusion. SRT targets the early stage of viral entry. It can bind to the S1 subunit of the S protein, especially the receptor binding domain (RBD), thus blocking S-hACE2 interaction and interfering with the proteolysis process of S protein. SRT is also effective against infection with SARS-CoV-2 PsV variants, including the newly emerging Omicron. The combination of SRT and other antivirals exhibits a strong synergistic effect against infection of SARS-CoV-2 PsV. The antiviral activity of SRT is independent of serotonin transporter expression. Moreover, SRT effectively inhibits infection of SARS-CoV-2 PsV and alleviates the inflammation process and lung pathological alterations in transduced mice in vivo. Therefore, SRT shows promise as a treatment option for COVID-19. IMPORTANCE The study shows SRT is an effective entry inhibitor against infection of SARS-CoV-2, which is currently prevalent globally. SRT targets the S protein of SARS-CoV-2 and is effective against a panel of SARS-CoV-2 variants. It also could be used in combination to prevent SARS-CoV-2 infection. More importantly, with long history of clinical use and proven safety, SRT might be particularly suitable to treat infection of SARS-CoV-2 in the central nervous system and optimized for treatment in older people, pregnant women, and COVID-19 patients with heart complications, which are associated with severity and mortality of COVID-19.
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Introduction: The SARS-CoV-2 public health emergency is leading to challenges for healthcare professionals, students, patients with COVID-19 and vulnerable persons, blocking the economic development and mental wellbeing. The pandemic containment measures and the fear of infection have caused psychological distress and inflamed underlying diseases Objective: To analyse the impact of the SARS-CoV-2 on the Mental Health in Friuli-Venezia Giulia Region, Italy, focusing on depression disorder and Antidepressants consumption. Furthermore, to assess the state of adverse event reports, from spontaneous signalling method, in patients taking Antidepressants Methods: For consumption data extraction I utilized the Regional Social and Health Information System. About reports of ADRs based on the National Pharmacovigilance Network I used the VigiSegn app. I accessed on INTERCheck System to balancing the risks and benefits of therapies. I compared two periods from 11.03.2019 to 10.03.2020 and from 11.03.2020 to 11.03.2021 separated by 11 March 2020, when the Director General of the WHO described the situation as a pandemic [1]. Antidepressants were classified using the ATC code system. Anonymous drug utilization was expressed in DDDs Results: Since 11 March 2020 I observed a marginal increase in consumption of sertraline, trazodone and vortioxetine. Regarding pharmaceutical spending there has been an increase of sertraline, trazodone, vortioxetine, bupropion, mirtazapine and venlafaxine. In the feminine gender, I observed an increase in AD consumption in the age ranges < 15 yrs, 16-19, 30-34, 55-59, 60-64, 70-74, 80-84, over 85;in the male gender in the ranges < 15 yrs, 20-24, 30-34, 55-59, 70-74, 80-84, over 85 (Picture 1). Concerning ADRs I analysed one tab about AD out of a total of 2146 medicines and vaccines reports in which the "hyponatremia" is reported on the warning label and caused by significant drug interactions Conclusion: Although the SARS-CoV-2 public health emergency is a rapidly evolving situation, the knowledge about the impact on the Mental Health is still limited. It is likely that the psychosocial demand will increase in the coming months. In the regional context, the thesis has highlighted a very slight rise in AD consumptions and a cant decrease spontaneous signalling method compared to the previous year. These scenarios also depend on the new balance of health services and the lack of access to care (10% of citizens has given up on care) [13, 14]. The healthcare systems will have to face important challenges and the success of the creation of high-quality healthcare reality will depend on the alliance between healthcare specialists
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CASE: 74 year old woman with history of anxiety, depression, and nonsecretory adrenal adenoma presented with two months of progressive night sweats. Initially, she described waking up damp all over, but without needing to change her sheets. Her weight had been stable, and she denied recent travel. Her recent health changes included starting sertraline and receiving the Moderna COVID vaccines. Her other medications included atorvastatin and lisinopril. Her vital signs were all within normal range and her physical exam was unremarkable. Night sweats described were mild, so work up began with checking a CBC with differential and a TSH level. Initial labs were normal. However, the patient called a week later with night sweats that were worsening. She also recalled being treated for tuberculosis at age fifteen. This prompted additional bloodwork including Quantiferon, ACTH, androstenedione, estradiol, testosterone, progesterone, and DHEAS levels, as well as urine catecholamines and metanephrines. Additionally, it was noted sertraline could be a potential cause of night sweats. The dose was halved with the goal to taper off and discontinue the medication. All lab results came back within normal limits, so CT scans of the chest/ abdomen/ pelvis were ordered, and blood cultures collected. Imaging showed an unchanged adrenal adenoma and blood cultures had no growth. Ultimately, after five months of symptoms, her night sweats completely resolved five weeks after stopping sertraline. IMPACT/DISCUSSION: When working up night sweats, first, the severity of symptoms should be determined and medications reviewed. Mild night sweats with no associated red flag symptoms (weight loss, lymphadenopathy, and fever) do not need immediate or extensive work up. Further work up is essential in the setting of any red flag symptoms. Without a clear etiology, the work up includes the following items: chest radiography along with bloodwork including Quantiferon test, CBC, TSH, HIV serology, and CRP. If these results are normal then a CT of the chest, abdomen, and pelvis could be obtained as well as a bone marrow biopsy. Little evidence exists to guide an exact order of workup for night sweats, so it remains the clinician's responsibility to determine which tests to prioritize. Classes of medications that tend to cause night sweats are cholinergics and anti-depressants. Anti-depressants most associated with night sweats include TCAs and SNRIs. Sertraline has been implicated as a cause of night sweats, but little data exists as to how often this occurs and how often severe presentations like the one described occur. Given that selective serotonin reuptake inhibitors are a first line treatment in depression, recognizing this adverse effect is important in primary care and could prevent unnecessary extensive work ups for night sweats. CONCLUSION: -An initial step in evaluating persistent night sweats should be medication review -Many antidepressants including sertraline can have night sweats as an adverse effect.
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Coronavirus disease 2019 (COVID-19) creates acute and long-lasting infection which results in respiratory, cardiovascular, and neuropsychiatric problems. Etiology of neuropsychiatric manifestations can be associated with immune system response, inflammatory cytokines, and also the stressors which are experienced by patients as feeling the risk of being infected by the virus, economic problems, and social distancing. We aimed to present a case of a 53-year-old patient whose suicide note was found and was admitted with depressive and catatonic symptoms 8 weeks after the recovery from COVID-19. Catatonia was suspected, and he was given lorazepam 1 mg. Shortly thereafter, he was entirely alert, cooperative, and oriented. As an advantage of this case, the patient in our report had not used medications for COVID-19 and so we could exclude the effect of medications to the pathophysiology of post-coronavirus disease symptoms. A wide spectrum of neuropsychiatric manifestations was observed in terms of diagnosis after COVID-19. Catatonia can break out in the post-infectious period as well as in the para-infectious period. There are limitations to figure out the direct invasion of coronavirus and the effect of the systemic inflammation to the central nervous system. Nevertheless, it should be considered that catatonia may be one of the clinical results of COVID-19.
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Objective: To report a pediatric case of severe, treatment-resistant, COVID-19-associated acute longitudinally extensive transverse myelitis (LETM). Background: Since the COVID-19 global pandemic, there is evolving literature reporting the neurological manifestations of the novel coronavirus. COVID-19-associated acute LETM was first reported in an elderly Asian man with lower-extremity weakness <1-week after onset of fever and respiratory distress. In childhood, this is rarely reported with only few reports of COVID-19-associated acute LETM. Design/Methods: We reviewed clinical and radiographic reports of our patient. We searched PubMed for literature using terms “transverse myelitis & COVID-19” and “pediatric transverse myelitis&COVID-19.” Results: A 5-year-old previously healthy boy presented with altered mental status. Prior to admission, he was exposed to COVID-19 and had consumed an unknown quantity of sertraline and risperidone tablets. Thereafter, he stated that he could not feel his legs, fell, and hit his head. In the emergency department, he was intubated. EKG revealed QTc prolongation (486-ms). SARS-CoV-2-PCR positive. Thereafter, flaccid quadriparesis, bulbar dysfunction, left-sided numbness, and hyperreflexia were noted;he communicated by eye blinking. MRI-spine revealed C1-C4 hyperintensity (T2-weighted) consistent with LETM;DWI negative for acute stroke. CSF basic labs, viral and MS panels, and ACE unremarkable. Serum anti-aquaporin-4 and myelin-oligodendrocyte-glycoprotein antibodies negative. Serum West Nile-IgM-IgG negative. Mycoplasma pneumoniae IgM-reactive, IgG-positive;confirmatory IgM immunofluorescence assay-negative. He received IV-methylprednisolone ×5-days, plasmapheresis ×10-sessions, pulsed steroid ×3-days. Minimal neurological improvement was noted. Repeat MRI-spine 2-weeks later unchanged. Tracheostomy and gastric tube were placed. He was transferred to a neurology topic. Conclusions: COVID-19-associated acute LETM in childhood can have a rapid, devastating clinical course. Clinicians should maintain a high-index of suspicion for LETM in COVID-19 pediatric patients presenting with neurological manifestations and consider alternative strategies for severe, treatment-resistant cases.
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The article examines incidence of psychosis in patients with Covid-19 infection. Topics discussed include link between viral infections and effects on the central nervous system, brief background of coronaviruses, and evidence that the neuropsychological stress associated with the diagnosis of Covid-19 as well as the therapeutic use of corticosteroids during care can induce psychosis.
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BACKGROUND: The Covid 19 pandemic might have impacted response to drug treatment in major depressive episode (MDE). We compared responses to three different antidepressant drugs, i.e., vortioxetine, sertraline, and trazodone, in outpatients with MDE during Major Depressive Disorder (MDD), Bipolar Disorder (BD), or schizophrenia and related psychoses (SSOPDs) during two time periods, i.e., prior to suffering Covid-19-related trauma and after suffering such trauma. METHODS: We conducted an observational study on clinically stabilised for at least 6 months outpatients with MDE during the course of MDD (N=58), BD (N=33), or SSOPDs (N=51). Patients, whose baseline assessments of Montgomery-Åsberg Rating Scale (MADRS), Hamilton Anxiety Rating Scale (Ham-A), Brief Psychiatric Rating Scale (BPRS), Visual Analogue Scale for Craving (VAS-crav) and World Health Organization Quality of Life, Brief version (WHOQOL-BREF) were available, were recruited at the time they suffered Covid-19-related traumas. Fifty patients, prior to the pandemic, when they were clinically stable, were treated with 15 mg/die vortioxetine, 44 with 450 mg/die trazodone, and 48 with 150 mg/die sertraline. After experiencing a major Covid-19-related personal trauma, patients showed clinical worsening which required dosage adjustment (20 mg/day vortioxetine; 600 mg/day trazodone, and 200 mg/day sertraline) and, for a part of them, a month of hospitalisation. Scores on the MADRS, Ham-A, BPRS, VAS-crav and WHOQOL-BREF were compared drug-wise and gender-wise with Student's t test for continuous variables and χ2 for categorical variables. RESULTS: The sample consisted of 142 outpatients (age, mean 39.63 ± 16.84; 70 men and 72 women); women were older than men (mean age 43.18 ± 17.61 vs. 35.98 ± 15.30; p=0.01). The two genders did not differ on other variables). For all treatments, symptoms worsening was observed at the time of trauma, followed by slow recovery with treatment readjustment. Trauma-related worsening in patients on vortioxetine was less intense than patients on the other two antidepressants and recovery was faster. All drugs were associated with an improvement in QoL. The vortioxetine group showed a lower hospitalisation rate (24%) than sertraline (35.4%) and trazodone (38.6%), but this was not significant (p=0.27). CONCLUSION: All drugs improved symptoms after Covid-19 trauma in patients with MDE, with vortioxetine showing a small advantage. No differences between vortioxetine, sertraline and trazodone were found as concerns the need for hospitalisation.
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Case Report Anorexia Nervosa is a mental health disorder with significant morbidity and mortality. Acute food refusal is one of the indications for admission. We present a patient who went to extreme lengths to restrict food intake, requiring intensive care sedation and ventilation to enable enteral feedings. 12 year old male, was admitted with symptoms of anorexia nervosa and BMI of 12.0, (<1%ile) with baseline BMI of 16 (25%ile), K of 3.3 and glucose of 54. He was treated with supervised eating on an inpatient pediatric floor with no need for enteral feeding. Psychiatry consultation confirmed the diagnosis of anorexia nervosa and recommended the addition of Olanzapine to his Sertraline. He was discharged pending placement in an eating disorder center after 21 days of hospitalization with discharge BMI of 14. He was followed as an outpatient by his pediatrician, dietician and counselor but unfortunately, he required readmission 11 days after discharge due to acute food refusal, with BMI that had dropped to 13.1. Patient was readmitted and started on nasogastric (NG) feeds but he became severely agitated, pulling NG out multiple times and continued to lose weight with BMI dropping to 12. Sedation was attempted to facilitate maintenance of NG feedings, with Benadryl, Haldol and Ativan, but was ineffective at levels deemed safe without compromising his airway and breathing. Due to severe malnourishment and unsuccessful NG feeds he was transferred to PICU for sedation, endotracheal intubation and continuous nasoduodenal (ND) tube feedings on two separate occasions while inpatient. He was able to wean from the ventilator but once awake he found ways to manipulate delivery of his calories, even finding scissors and cutting the ND tube. The patient ultimately agreed to eat in order to avoid replacement of the feeding tube. He was finally transferred to an eating disorder facility, with a BMI of 13.9 and persistent anorexia thinking with restriction of eating anything but pizza. Patient completed three months of an inpatient program and had significant improvement in BMI to 19.3 (70%ile). He was subsequently discharged for continued outpatient follow-up and since discharge from the eating disorder center, his BMI has shown steady improvement in outpatient follow-up. He shows no signs of food refusal and is doing well with Family Based Therapy. This case highlights several unique characteristics in management of eating disorder patients. The age and being male along with extreme food refusal and resistance to enteral feeding that led to the requirement of deep sedation are quite unusual and not well described in the medical literature. The severity of his illness was a significant barrier to inpatient placement. In addition, despite a nationwide attempt to find an inpatient facility for him, which took several weeks, we identified shortages in eating disorder beds that have been exacerbated by the COVID-19 pandemic.
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Case Report Transverse myelitis is the segmental inflammation of the spinal cord with motor and sensory abnormalities at and below the level of the lesion. Often, the etiology is unknown but may be attributed to autoimmune conditions or viruses. Here we describe a rare case of transverse myelitis secondary to severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]/coronavirus disease (COVID-19). Case A 5-year-old male with a history of asthma presented for vomiting and altered mental status. The patient was noted to be altered, lethargic, and in respiratory distress. Intubation was performed. After family collateral was obtained, it was revealed that patient possibly ingested Sertraline and/or Risperidone at an unknown time prior to arrival. History also revealed that he had slurred speech, ataxia, and a fall with trauma to forehead 1 day prior to arrival. He tested positive for COVID-19 via PCR and chest x-ray revealed RLL consolidation. Dexamethasone was started. When sedation was weaned in hopes of extubation, patient was noted to be alert, but not moving extremities and had minimal gag and cough reflex. MRI of Brain and Spine were conducted and revealed findings suggestive of long segment transverse myelitis involving C2 to C3. LP was performed with unremarkable CSF studies and IV Solumedrol was started. In light of active COVID-19 infection, and worsening respiratory status, patient started on 5 days Remdesivir. Further, patient underwent ten sessions of plasmapheresis. Repeat MRI was consistent with previous. Physical and occupational therapy initiated at the onset of illness in hopes of achieving musculoskeletal improvement. Patient had some minimal musculoskeletal improvement, however, given his condition, decision was made for patient to undergo placement of gastrostomy and tracheostomy tubes. Patient was weaned off of sedatives and withdrawal was treated with a clonidine taper. Once stabilized, patient was transferred to neurological inpatient rehabilitation center. Discussion Neurological manifestations in children affected by SARS-CoV-2 are relatively common but are often non-specific. Worldwide data reports only 1% of children with COVID-19 present with severe symptoms of encephalopathy, seizures, and meningeal signs. Pathophysiology is multifactorial, including direct invasion of the CNS, vascular insufficiency, immune dysregulation and autoimmunity. Imaging is paramount in the diagnosis of transverse myelitis. Treatments are emerging and may include steroids, immunoglobulin, plasmapheresis, and monoclonal antibodies. Conclusion Much is unknown about COVID-19. Information is emerging and evolving daily. Cases of transverse myelitis in COVID-19 have been reported in few adult patients and minimal pediatric patients. Practitioners should keep transverse myelitis on their list of differentials for neurological complications of SARS-CoV-2 infections and initiate aggressive treatment with a multidisciplinary approach.
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Introduction: Depression was reported in 30–40% of patients at one, three, and six months following COVID-19 [1]. The host immune response to SARS-CoV-2 infection and related severe systemic inflammation seems to be the main mechanism contributing to the development of post-COVID depression. Emerging literature suggests anti-inflammatory and antiviral properties of antidepressants in the treatment of SARS-CoV-2 infection [2]. We hypothesized that post-COVID depression, triggered by infection and sustained by systemic inflammation, could particularly benefit from antidepressants. Thus, the present study aims to investigate the efficacy of SSRI in treating post-COVID depression. Methods: We included 58 adults patients who showed depressive episodes in the six months following COVID-19. We excluded patients if they showed: other psychiatric comorbidities, ongoing treatment with antidepressants or neuroleptics, somatic disease and medications known to affect mood. The severity of depression was rated at baseline and after for four weeks from the start of the treatment on the Hamilton Depression Rating Scale (HDRS) and response was considered when the patients achieved a 50% HDRS reduction after treatment. Statistical analyses to compare group means and frequencies (Student's t-test, Pearson χ2 test) were performed. To investigate changes in HDRS scores over time, repeated measures ANOVAs (according to sex, mood disorder history, and antidepressant molecule) were performed. Results: We found that 53 (91%) patients showed a clinical response to antidepressant treatment. Age, sex, mood disorder history, and hospitalization for COVID did not affect the response rate. Patients were treated with sertraline (n=26), citalopram (n=18), paroxetine (n=8), fluvoxamine (n=4), and fluoxetine (n=2). From baseline to follow-up, patients showed a significant decrease over time of HDRS score (F=618.90, p<0.001), irrespectively of sex (0.28, p=0.599), mood disorder history (F=0.04, p=0.834), and drug used (F=1.47, p=0.239). Discussion: Common knowledge highlights that among antidepressant-treated patients, response rates are moderate (40–60%). On the contrary, we observed a rapid response to the first-line antidepressants in more than 90% of patients irrespectively of clinical variables, thus suggesting a higher antidepressant response rate in post-COVID depression. The pathophysiology of post-COVID neuropsychiatric sequelae mainly entails severe systemic inflammation and subsequent neuroinflammation. In this context, we have previously found that one and three months after COVID-19, the severity of depression was predicted by the baseline systemic immune-inflammation index (SII) [3,4]. Furthermore, we found a protective effect of the IL-1β and IL-6 receptor antagonist against post-COVID depression possibly associated with their effect in dampening SII [5]. Mounting evidence suggests that antidepressants may a) decrease markers of inflammation;b) may inhibit acid sphingomyelinase preventing the infection of epithelial cells with SARS-CoV-2;c) may prevent the COVID-19 related cytokine storm by stimulating the σ-1 receptor;d) may exert antiviral effects via lysosomotropic properties;e) may inhibit platelets activation [2]. In conclusion, we hypothesized that post-COVID depression could particularly benefit from antidepressants since this molecules have anti-inflammatory and antiviral properties, pass the BBB and accumulate in the CNS, thus preventing the neuro-inflammation triggered by SARS-CoV-2 and associated with post-COVID depression. No conflict of interest
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Introduction. The Covid 19 has probably altered the epidemiology of mental disorders worldwide, with their incidence which is likely to have increased during the pandemic [1,2]. It is possible that it has impacted response to drug treatment in psychiatric conditions, resulting in differential hospitalisation rates. Hence, we compared the responses to three different antidepressant drugs in outpatients with a major depressive episode (MDE) in the course of Major Depressive Disorder (MDD) and Bipolar Disorder (BD) during two time periods, i.e., prior to suffering Covid-19–related trauma and after suffering such trauma. Methods. We conducted an observational study on outpatients with MDE during their course of MDD (N=58) or BD (N=84)who were clinically stabilised for at least 6 months and treated with antidepressants, antipsychotics or mood stabilisers according to recent treatment guidelines [3,4]. Outpatients, of whom we had baseline assessments of Montgomery-Åsberg Rating Scale (MADRS) and Hamilton Anxiety Rating Scale (Ham-A), were recruited at the time they suffered Covid-19–related traumas, defined as developing Covid-19 infection or witnessing Covid-19 infection in a close person, death of a loved one, domestic violence, or job loss. Fifty patients were being treated with 15 mg/day oral vortioxetine, 46 with 450 mg/day oral extended-release trazodone (ERT), and 46 with 150 mg/day oral sertraline. We compared their scores on the MADRS, Ham-A, and WHOQOL-2.0-BREF drug-wise and gender-wise. We used Student's t test for continuous variables and the χ2 test for categorical variables. Results. The sample consisted of 142 outpatients (age, mean 39.63 ± 16.84;70 men and 72 women);women were older than men (mean age 43.18 ± 17.61 vs. 35.98 ± 15.30;p=0.01). The two genders did not differ on other variables). There was a main effect of time for MADRS scores (F(1.000,130.000)=147.292, p<0.001, η2=0.531;from 13.75 ± 4.60 to 20.38 ± 7.06) and Ham-A scores (F(1.000,130.000)=100.260, p<0.001, η2=0.435;from 13.41±7.14 to 20.61±7.99) and an interaction effect, i.e., a Time × Treatment effect (F(2.000,130.000)=10.376, p<0.001, η2=0.138) for MADRS and (F(2.000,130.000)=6.836, p=0.002, η2=0.095) for Ham-A, with a lower impairment for the vortioxetine group (from 14.20±3.60 to 17.26±5.44) than sertraline (from 13.56±4.29 to 22.44±6.59) and trazodone (from 13.57±5.85 to 21.68±7.06) for MADRS and for Ham-A (vortioxetine from 13.96±6.26 to 17.78±7.09 better than sertraline, from 13.79 ±8.36 to 22.77±7.62 and trazodone, from 12.39±6.69 to 21.48±8.55) from the pre-Covid-19 to the post-Covid-19–related trauma period. Improved QoL from the Covid-19–related trauma period to 1 month post-trauma was shown for trazodone (from 62.16±15.44 to 67.90±13.74), but not vortioxetine (from 61.56±13.89 to 63.50±15.60) or sertraline (from 63.89±13.37 to 62.08±15.10). The vortioxetine group showed a lower hospitalisation rate (24%) than sertraline (35.4%) and trazodone (38.6%), but this was not significant (p=0.27). Conclusion. We found all drugs to improve depression and anxiety scores with vortioxetine showing a small advantage over the others in patients with and MDE during the course of MDD or BD. Trazodone improved QoL faster than other drugs. No differences between vortioxetine, sertraline and trazodone were found as concerns the need for hospitalisation. No conflict of interest
ABSTRACT
Introduction: The World Health Organization postulated Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) is a pandemic situation in the whole world [1]. Although the main damaging of SARS-Cov-2 in the human organism is linked to its severe acute respiratory illness, a new coronavirus, SARS-CoV-2 implicates in the various central nervous system impairments and deteriorations [1,2]. The major clinical outcomes of COVID-19 in the brain are associated with its deleterious neurological and mental health actions [3]. Currently, we do not know exactly how actually SARS-CoV-2 might negatively alter the brain functions in humans. Today, there are limited findings concerning the studying of neuropsychiatric action for SARS-Cov-2 in humans after COVID-19 disease. The aim of the present study was to compare the efficacy of SSRIs (escitalopram, sertraline and fluoxetine) for 6 months therapy on the affective profile of man and women with the first Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) cases following COVID-19 disease without any previous psychiatric diagnosis. Methods. For the assessment of affective profile in man and women (30-55 years) with the first MDD or GAD cases after COVID-19 disease, we used the different tests: Montgomery-Asberg Depression Rating Scale (MADRS) and anxiety scale (ShARS Scale). The hormonal and Vitamin D3 levels in the serum blood were measured by immune-enzyme analysis before and after SSRIs therapy. Results. After 6 months of SSRIs therapy, MADRS Scale showed a significant improvement of the depressive manifestations in both men and women with the first MDD case after COVID-19 (p%26lt;0,05). However, these patients of both gender demonstrated significantly high anxiety level by ShARS Scale. We found that SSRIs were able to reduce anxiety level only on 25%25 in man or on 35%25 in women with the first MDD case after COVID-19 before treatment (p%26lt;0,05). Interestingly, MADRS Scale showed a similar improvement of the depressive manifestations in both men and women with the first GAD case after COVID-19 treated with SSRIs for 6 months (p%26lt;0,05). Also, women with the first GAD case after COVID-19 treated with SSRIs had the parameters of their affective profile that were similarly to those of control group. The reduction of depressive symptoms in women with the first GAD case after COVID-19 treated with SSRIs was associated with restoration of cortisol concentrations in the serum blood compared to the initial levels. Conclusion: Thus, our pilot clinical study clearly demonstrated that SSRIs treatment have a beneficial effect on the depressive symptoms in patients of both gender with the first MDD or GAD cases after COVID-19. However, SSRIs therapy alone failed to produce the decrease of anxiety in the patients of both gender with the first MDD or GAD cases after COVID-19. In light of the demonstrated data, the importance of truly adequate treatment to the long-term neuropsychiatric outcomes of COVID-19 in patients of both gender, further randomized clinical trials involving new pharmacological therapies are needed in the future. No conflict of interest
ABSTRACT
Depression-the global crisis hastened by the coronavirus outbreak, can be efficaciously treated by the selective serotonin reuptake inhibitors (SSRIs). Cyclodextrin (CD) inclusion complexation is a method of choice for reducing side effects and improving bioavailability of drugs. Here, we investigate in-depth the ß-CD encapsulation of sertraline (STL) HCl (1) and fluoxetine (FXT) HCl (2) by single-crystal X-ray diffraction and DFT complete-geometry optimization, in comparison to the reported complex of paroxetine (PXT) base. X-ray analysis unveiled the 2:2 ß-CD-STL/FXT complexes with two drug molecules inserting their halogen-containing aromatic ring in the ß-CD dimeric cavity, which are stabilized by the interplay of intermolecular O2-Hâ¯N1-Hâ¯O3 H-bonds, C3/C5-Hâ¯π and halogenâ¯halogen interactions. Similarly, the 1:1 ß-CD-tricyclic-antidepressant (TCA) complexes have an exclusive inclusion mode of the aromatic ring, which is maintained by C3/C5-Hâ¯π interactions. By contrast, the 2:1 ß-CD-PXT complex has a total inclusion that is stabilized by host-guest O6-Hâ¯N1-Hâ¯O5 H-bonds and C3-Hâ¯π interactions. The inherent stabilization energies of 1 and 2 evaluated using DFT calculation suggested that the improved thermodynamic stabilities via CD encapsulation facilitates the reduction of drug side effects. Moreover, the SSRI conformational flexibilities are thoroughly discussed for understanding of their pharmacoactivity.