We regularly receive questions about the off-label* use of SSRIs (a group of medications that affect mood) for post-COVID symptoms. We do not advise whether a doctor should prescribe the medication. We are simply sharing the available information on the use of SSRIs for post-COVID symptoms.
Selective serotonin reuptake inhibitors (SSRIs) are medications developed to treat mood disorders such as depression and anxiety. In post-COVID patients, SSRIs may be considered for symptoms such as fatigue, brain fog, memory impairment, difficulty concentrating, increased sensitivity to stimuli, and severe fatigue and/or post-exertional malaise (PEM).
There are several SSRIs, for example: citalopram, escitalopram, fluoxetine, and fluvoxamine. SSRIs influence the immune system and have an anti-inflammatory effect. Furthermore, there are indications that SSRIs have a calming effect on neuroinflammation in the brain, which can occur post-COVID. Therefore, using an SSRI could help with common post-COVID symptoms such as difficulty concentrating, memory loss, fatigue, and low mood.
On the website https://www.sepsis-en-daarna.nl/kan-ssri-remmer-helpen-bij-long-covid-klachten-en-ernstige-klachten-na-sepsis-interview-met-carla-rus-oud-neuropsychiater/ Psychiatrist Carla Rus has published more information on the use of SSRIs in post-COVID [1].
What is known about the effect on post-COVID syndrome?
In post-COVID-19, disruptions in the production of serotonin and kynurenine can occur. This disruption may play a significant role in the development of post-COVID-19 symptoms. Further research into this could provide valuable insights into the development of post-COVID-19 and potential treatments in the future [2].
In November 2023, Carla Rus described her initial findings from a group of post-COVID patients using SSRIs [3]. She indicated that over 60% of patients experienced improvement. These are promising results, but the study was not compared with a placebo group, and the results are based on questionnaires in which patients themselves indicated the effect (or had effect) of SSRI use on their symptoms. Therefore, it is not immediately possible to translate this information to "the average post-COVID patient."
The effect of SSRIs on post-COVID complaints therefore needs further investigation.
Use of SSRIs
Like all medications, SSRIs have side effects. These can be temporary and subside once the body becomes more accustomed to the drug. Therefore, it's important to gradually increase the dose. When the drug is stopped, it should also be gradually reduced. The effect of an SSRI becomes noticeable over several weeks.
It's becoming increasingly clear that people with post-COVID symptoms may be more sensitive to side effects. Therefore, the advice is: "start low, go slow" when prescribing medication for people with post-COVID symptoms, including SSRIs. In patients with orthostatic symptoms (such as postural orthostatic tachycardia syndrome – POTS), SSRIs can worsen symptoms. This effect is stronger with some SSRIs than with others.
An SSRI must be prescribed by a physician, such as a general practitioner or psychiatrist. If necessary, the (GP) physician can discuss its use for post-COVID symptoms with one of C-support's medical advisors. Contact us via Contact – C-support.
* Off-label use is prescribing a medication for a condition, age group, or route of administration for which the medication is not officially registered. This is used when there is no registered treatment available (yet), such as in the post-COVID period. However, this does entail potential risks. This is because the efficacy and safety have not been assessed for that specific application. Off-label use is only permitted if the physician properly informs the patient about the risks and the patient gives consent.
