Citalopram for long COVID
CITALOPRAM
What is citalopram (Celexa)?
Used for depression, citalopram belongs to a class of medication called selective serotonin reuptake inhibitors (SSRIs). Serotonin is a molecule in the body that aids in mood, sexual desire, sleep, digestion, wound healing, bone health, and blood clotting. It is often referred to in psychology as the “happy” chemical. In conditions like depression, the brain is dealing with an imbalance of chemicals such as serotonin. SSRIs, like citalopram, work by keeping serotonin in the space where it can readily be available for bodily processes.
What is the connection between citalopram and long-COVID?
In those diagnosed with long-COVID, many suffer from “brain fog”; decreased cognitive acuity, memory deficits, poor focus, reduced ability to multitask, and reduced concentration [2]. The proposed reason is that during a COVID-19 infection, the body’s immune response becomes activated, causing heavy amounts of inflammation. Additionally, serotonin has been shown to have an effect against viral inflammation by blocking certain viruses (like HIV-1) in the cells. Serotonin can decrease cytokine production, promoting the immune response [2]. This inflammation affects the central nervous system (CNS), brain, and spinal cord.
Researchers have begun to look at the use of citalopram to help in long-COVID due to its effects on serotonin and its role in depression. One trial conducted in 60 patients showed a decrease in depression when treated with citalopram [2]. A second study found the use of citalopram significantly contributed to a reduction in long-COVID symptoms [3]. Although more research needs to be conducted to support the use of SSRIs for inflammation-related long-COVID, for symptoms of depression associated with long-COVID, citalopram may be a viable option [4].
References:
2https://www.nature.com/articles/s41598-023-45072-9
3https://link.springer.com/article/10.1007/s40267-022-00975-x
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Colchicine for long COVID
COLCHICINE
What is colchicine (Colcrys)?
Colchicine is a medication prescribed for the prevention and treatment of gout. Gout is caused by a buildup of uric acid crystals in the joint space. These crystals are hard and very sharp, causing tremendous pain. Colchicine works by reducing the inflammation resulting from the buildup of these crystals [1].
Does colchicine play a role in long-COVID?
As colchicine decreases inflammation, researchers have turned to it in hopes it may reduce symptoms associated with long-COVID. Researchers theorize that those affected by long-COVID live in a state of inflammation. COVID-19 sets off a cytokine storm, an immune system overresponse. Although they are not actively infected, patients are still shedding the virus, resulting in symptoms of “brain fog,” exercise intolerance, and shortness of breath.
Currently, results only from studies looking at adding colchicine to hospitalized patients exist. These studies aim to see if adding colchicine can improve patient outcomes. One study looked at 72 patients, 36 using a placebo and 36 using colchicine, and found after ten days of treatment, the use of supplemental oxygen and hospitalized were reduced [2]. Another study found that patients treated at the outpatient level, diagnosed as COVID-19 positive by a PCR test, colchicine did help prevent hospitalizations and death after 30 days of treatment [3].
Colchicine does show some benefit in decreasing symptoms in those actively infected with COVID-19, so it may also have an indication in the long-COVID population. A study in India is currently looking at the relationship between colchicine and long-COVID patients to determine whether colchicine is better at improving functional outcomes and respiratory/mental health outcomes than placebo. However, this study is ongoing, and results are not yet available [4].
References:
1https://www.nhs.uk/medicines/colchicine/about-colchicine/
2https://rmdopen.bmj.com/content/7/1/e001455
3https://www.thelancet.com/action/showPdf?pii=S2213-2600%2821%2900222-8
4https://www.georgeinstitute.org/projects/Colchicine-for-Long-COVID
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Dexmethylphenidate for long COVID
DEXMETHYLPHENIDATE
What is dexmethylphenidate, and how does it work?
Dexmethylphenidate is a stimulant medication that belongs to the drug class amphetamines. This medication acts on the central nervous system (CNS) by increasing levels of two chemicals, dopamine and norepinephrine, in the brain. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure. Dopamine plays a key role in movement and affects motivation, perception of reality, and the ability to experience pleasure [1]. By increasing these levels of chemicals, it leads to an increase in focus and attention. Dexmethylphenidate is a controlled substance and does have the potential for abuse if used in a manner inconsistent with how it is prescribed.
How can dexmethylphenidate be used in long-COVID?
Sufferers of long-COVID often deal with “brain fog,” a persistent cognitive defect resulting in memory problems, poor focus, and decreased ability to concentrate. Although the reasoning is still unclear, researchers think COVID-19 may linger in the brain for months. Even though it does not cause an active infection, it is a foreign substance in the body. This leads to constant attack by the immune system, causing inflammation. Over time, the continuous inflammation manifests as “brain fog” symptoms [2].
Stimulants like dexmethylphenidate can improve focus, attention span, and even fatigue. A case study completed in 2022 showed benefits when using methylphenidate, a cousin to dexmethylphenidate and other agents, to help reduce “brain fog” [3].
The chronic fatigue many patients face may be mitigated using dexmethylphenidate as well. A study found that treatment with methylphenidate was significantly better than placebo in 17% of patients regarding their fatigue symptoms [4]. Although current recommendations do not advocate for the use of stimulants, or dexmethylphenidate in particular, to treat long-COVID or symptoms of long-COVID, for those suffering from “brain fog” or fatigue, they may be an attractive option to those looking for symptom management.
References:
1https://americanaddictioncenters.org/antidepressants-guide/ndris#
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102822/
4https://pubmed.ncbi.nlm.nih.gov/16443425/
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Dextroamphetamine and Amphetamine for long COVID
DEXTROAMPHETAMINE/AMPHETAMINE
What is dextroamphetamine and amphetamine?
Dextroamphetamine and amphetamine is a stimulant medication that belongs to the drug class amphetamines. This medication acts on the central nervous system (CNS) by increasing levels of two chemicals, dopamine and norepinephrine, in the brain. Norepinephrine is thought to play a role in the body’s stress response and helps to regulate sleep, alertness, and blood pressure. Dopamine plays a key role in movement and affects motivation, perception of reality, and the ability to experience pleasure [1]. By increasing these levels of chemicals, it leads to an increase in focus and attention. Dextroamphetamine and amphetamine are controlled substances and do have the potential for abuse if used in a manner inconsistent with how it is prescribed.
How can dextroamphetamine and amphetamine be used in long-COVID?
Sufferers of long-COVID often deal with “brain fog,” a persistent cognitive defect resulting in memory problems, poor focus, and decreased ability to concentrate. Although the reasoning is still unclear, researchers think COVID-19 may linger in the brain for months afterward. Even though it does not cause an active infection, it is a foreign substance in the body. This leads to constant attack by the immune system, causing inflammation. Over time, the continuous inflammation manifests as “brain fog” symptoms [2].
Stimulants, such as dextroamphetamine and amphetamine, can improve focus, attention span, and even fatigue. A case study completed in 2022 showed benefits when using dextroamphetamine and amphetamine, along with other agents, to help reduce “brain fog” [3]. Although there have been no formal studies conducted on using dextroamphetamine and amphetamine for “brain fog,” one provider stated he has been using it, in conjunction with behavioral exercises, as a treatment option. He saw improved memory, attention, fatigue, and concentration difficulties [4].
Although current recommendations do not advocate for the use of stimulants to treat long-COVID or symptoms of long-COVID, for those suffering from “brain fog” or fatigue, it may be an attractive option to those looking for symptom management.
References:
1https://americanaddictioncenters.org/antidepressants-guide/ndris#
3https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10102822/
4https://www.ohsu.edu/sites/default/files/2023-02/PCR23-Mon-18-AndersonWM.pdf
Active Clinical Trials: Long COVID, Dextroamphetamine | Card Results | ClinicalTrials.gov
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Doxycycline for long COVID
DOXYCYCLINE
What is doxycycline (Vibramycin)?
Doxycycline is an antibiotic used to treat infections such as pneumonia, urinary tract infections, and sexually transmitted diseases. It works by binding to the region of bacteria that creates proteins, inhibiting new protein synthesis. The lack of proteins for the bacteria causes bacterial death.
What is the connection between doxycycline and COVID-19?
Historically, doxycycline has been used for bacterial infections; however, researchers have found some evidence that it may also be helpful in the case of COVID-19 viral infection. It contains anti-inflammatory and immune response-modulating properties [1]. In several case reports of patients with COVID-19, the administration of doxycycline reduced the need for ICU admission [2].
Currently, doxycycline research is focused on preventing long-COVID and decreasing the severity of the disease. How doxycycline fares in helping with long-COVID remains unknown. There is no evidence supporting its use for long-COVID in symptom management or treatment. Further research needs to be conducted to establish doxycycline’s role in COVID-19. However, for preventing escalation into long-COVID, doxycycline does show promise in the few case reports available.
References:
1https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464303/
2https://www.medrxiv.org/content/10.1101/2022.01.30.22269685v1
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