Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2
Abstract Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associ...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Publishing Group
2022-08-01
|
| Series: | Translational Psychiatry |
| Online Access: | https://doi.org/10.1038/s41398-022-02109-3 |
| _version_ | 1811188792639356928 |
|---|---|
| author | Bradley A. Fritz Nicolas Hoertel Eric J. Lenze Farid Jalali Angela M. Reiersen |
| author_facet | Bradley A. Fritz Nicolas Hoertel Eric J. Lenze Farid Jalali Angela M. Reiersen |
| author_sort | Bradley A. Fritz |
| collection | DOAJ |
| description | Abstract Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associated with reduced emergency department (ED) or hospital visits among ambulatory patients with SARS-CoV-2 infection. This retrospective cohort study included adult patients (N = 25 034) with a positive SARS-CoV-2 test performed in a non-hospital setting. Logistic regression analyses tested associations between home use of antidepressant medications and a composite outcome of ED visitation or hospital admission within 30 days. Secondary exposures included individual antidepressants and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. Patients with antidepressant exposure were less likely to experience the primary composite outcome compared to patients without antidepressant exposure (adjusted odds ratio [aOR] 0.89, 95% CI 0.79–0.99, p = 0.04). This association was only observed with daily doses of at least 20 mg fluoxetine-equivalent (aOR 0.87, 95% CI 0.77–0.99, p = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80–1.11, p = 0.48). In exploratory secondary analyses, the outcome incidence was also reduced with exposure to selective serotonin reuptake inhibitors (aOR 0.87, 95% CI 0.75–0.99, p = 0.04), bupropion (aOR 0.70, 95% CI 0.55–0.90, p = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77–0.99, p = 0.03). Antidepressant exposure was associated with a reduced incidence of emergency department visitation or hospital admission among SARS-CoV-2 positive patients, in a dose-dependent manner. These data support the FIASMA model of antidepressants’ effects against COVID-19. |
| first_indexed | 2024-04-11T14:24:11Z |
| format | Article |
| id | doaj.art-34433a9cdbeb425a9058d4fdb84d05af |
| institution | Directory Open Access Journal |
| issn | 2158-3188 |
| language | English |
| last_indexed | 2024-04-11T14:24:11Z |
| publishDate | 2022-08-01 |
| publisher | Nature Publishing Group |
| record_format | Article |
| series | Translational Psychiatry |
| spelling | doaj.art-34433a9cdbeb425a9058d4fdb84d05af2022-12-22T04:18:55ZengNature Publishing GroupTranslational Psychiatry2158-31882022-08-011211910.1038/s41398-022-02109-3Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2Bradley A. Fritz0Nicolas Hoertel1Eric J. Lenze2Farid Jalali3Angela M. Reiersen4Department of Anesthesiology, Washington University School of MedicineAssistance Publique-Hôpitaux de Paris, Hôpital Corentin-CeltonDepartment of Psychiatry, Washington University School of MedicineDepartment of Gastroenterology, Saddleback Medical GroupDepartment of Psychiatry, Washington University School of MedicineAbstract Antidepressants have previously been associated with better outcomes in patients hospitalized with COVID-19, but their effect on clinical deterioration among ambulatory patients has not been fully explored. The objective of this study was to assess whether antidepressant exposure was associated with reduced emergency department (ED) or hospital visits among ambulatory patients with SARS-CoV-2 infection. This retrospective cohort study included adult patients (N = 25 034) with a positive SARS-CoV-2 test performed in a non-hospital setting. Logistic regression analyses tested associations between home use of antidepressant medications and a composite outcome of ED visitation or hospital admission within 30 days. Secondary exposures included individual antidepressants and antidepressants with functional inhibition of acid sphingomyelinase (FIASMA) activity. Patients with antidepressant exposure were less likely to experience the primary composite outcome compared to patients without antidepressant exposure (adjusted odds ratio [aOR] 0.89, 95% CI 0.79–0.99, p = 0.04). This association was only observed with daily doses of at least 20 mg fluoxetine-equivalent (aOR 0.87, 95% CI 0.77–0.99, p = 0.04), but not with daily doses lower than 20 mg fluoxetine-equivalent (aOR 0.94, 95% CI 0.80–1.11, p = 0.48). In exploratory secondary analyses, the outcome incidence was also reduced with exposure to selective serotonin reuptake inhibitors (aOR 0.87, 95% CI 0.75–0.99, p = 0.04), bupropion (aOR 0.70, 95% CI 0.55–0.90, p = 0.005), and FIASMA antidepressant drugs (aOR 0.87, 95% CI 0.77–0.99, p = 0.03). Antidepressant exposure was associated with a reduced incidence of emergency department visitation or hospital admission among SARS-CoV-2 positive patients, in a dose-dependent manner. These data support the FIASMA model of antidepressants’ effects against COVID-19.https://doi.org/10.1038/s41398-022-02109-3 |
| spellingShingle | Bradley A. Fritz Nicolas Hoertel Eric J. Lenze Farid Jalali Angela M. Reiersen Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 Translational Psychiatry |
| title | Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 |
| title_full | Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 |
| title_fullStr | Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 |
| title_full_unstemmed | Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 |
| title_short | Association between antidepressant use and ED or hospital visits in outpatients with SARS-CoV-2 |
| title_sort | association between antidepressant use and ed or hospital visits in outpatients with sars cov 2 |
| url | https://doi.org/10.1038/s41398-022-02109-3 |
| work_keys_str_mv | AT bradleyafritz associationbetweenantidepressantuseandedorhospitalvisitsinoutpatientswithsarscov2 AT nicolashoertel associationbetweenantidepressantuseandedorhospitalvisitsinoutpatientswithsarscov2 AT ericjlenze associationbetweenantidepressantuseandedorhospitalvisitsinoutpatientswithsarscov2 AT faridjalali associationbetweenantidepressantuseandedorhospitalvisitsinoutpatientswithsarscov2 AT angelamreiersen associationbetweenantidepressantuseandedorhospitalvisitsinoutpatientswithsarscov2 |