Psychotropic drug repurposing for COVID-19: A Systematic Review and Meta-Analysis

Several psychotropic drugs, including antidepressants (AD), mood stabilizers, and antipsy-chotics (AP) have been suggested to have favorable effects in the treatment of COVID-19. The aim of this systematic review and meta-analysis was to collect evidence from studies concerning the scientific evidence for the repurposing of psychotropic drugs in COVID-19 treat-ment. Two independent authors searched PubMed-MEDLINE, Scopus, PsycINFO, and ClinicalTri-als.gov databases, and reviewed the reference lists of articles for eligible articles published up to 13th December 2021. All computational, preclinical and clinical (observational and/or RCTs) studies on the effect of any psychotropic drug on Sars-CoV-2 or patients with COVID-19 were considered for inclusion. We conducted random effect meta-analyses on clinical studies reporting the effect of AD or AP on COVID-19 outcomes. 29 studies were included in the synthe-sis: 15 clinical, 9 preclinical, and 5 computational studies. 9 clinical studies could be included in the quantitative analyses. AD did not increase the risk of severe COVID-19 (RR = 1.71; CI 0.65-4.51) or mortality (RR = 0.94; CI 0.81-1.09). Fluvoxamine was associated with a reduced risk of mortality for COVID-19 (OR = 0.15; CI 0.02-0.95). AP increased the risk of severe COVID-19 (RR = 3.66; CI 2.76-4.85) and mortality (OR = 1.53; CI 1.15-2.03). Fluvoxamine might be a possible candidate for psychotropic drug repurposing in COVID-19 due to its anti-inflammatory and antiviral potential, while evidence on other AD is still controversial. Although AP are asso-ciated with worse COVID-19 outcomes, their use should be evaluated case to case and ongoing treatment with antipsychotics should be not discontinued in psychiatric patients. (c) 2022 Elsevier B.V. and ECNP. All rights reserved.

Automated summary

This systematic review and meta-analysis investigates the repurposing of psychotropic drugs in the treatment of COVID-19. The study finds that antidepressants do not significantly affect the risk and mortality of COVID-19, while fluvoxamine may have potential in reducing mortality risk. Antipsychotics may increase the risk of severe COVID-19 and mortality, but their use in psychiatric patients should be evaluated on a case-by-case basis.