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Antidepressants have been studied as a treatment for COVID-19 infection because some of them appear to have anti-inflammatory effects. There is even a randomized trial of fluvoxamine, which had a modest effect on reducing severe clinical worsening. This benefit might actually be a class effect of serotonergic antidepressants, although a recent retrospective cohort study of 80,000 patients suggested that fluoxetine as well as fluvoxamine might yield somewhat greater benefit than other serotonin reuptake inhibitors (SRIs). But what about psychiatric medications that might increase risk from COVID-19 infection, like clozapine? With its potential for neutropenia, should clozapine be held if a patient becomes COVID positive?
Hi! Jim Phelps here for the Psychopharmacology Institute. Like the SRIs, clozapine has serotonergic effects, but it acts as an antagonist at 5-HT2 receptors rather than blocking reuptake. Could that yield an opposite effect on COVID-19 risk? Moreover, clozapine has complex immunomodulatory effects, not just risk
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