Trending Clinical Topic: Antidepressant

Ryan Syrek


December 04, 2020

Each week, we identify one top search term, speculate about what caused its popularity, and provide an infographic on a related condition. If you have thoughts about what's trending and why, share them with us on Twitter or Facebook. Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

From encouraging news about use in patients with COVID-19 and dementia prevention to new findings about routine indications, various information about antidepressants resulted in this week's top trending clinical topic.

Although most treatments for COVID-19 have been targeted at the sickest patients, a recent study of patients with mild symptomatic disease found encouraging results with the use of the antidepressant fluvoxamine (see Infographic below). The preliminary randomized controlled trial of 152 nonhospitalized adults found that the drug may help prevent respiratory deterioration. Although the study was small and had a short follow-up, the findings are encouraging, as fluvoxamine is safe, widely available, and affordable and can be orally administered. Further investigation is likely to be met with great interest, as tools to prevent mild COVID-19 from progressing to severe disease are desperately needed.

A different antidepressant may have the potential to prevent another significant disease. A recent study found that the selective serotonin reuptake inhibitor (SSRI) escitalopram lowers amyloid-beta-42 levels in the cerebrospinal fluid of cognitively normal older adults, suggesting a potential role for these drugs in the prevention of Alzheimer's disease. Whether this reduction will translate to significant clinical benefit is unclear. However, researchers suggest that the findings may lead to the development of more targeted therapy or point to drug combinations that could promote   amyloid reduction. The role of SSRIs in the prevention of dementia, specifically Alzheimer's disease, is ongoing.

A recent study found that adding a second-generation antipsychotic to an antidepressant used to treat depression increases mortality risk for middle-aged adults. The large, observational study included 39,582 patients who had been diagnosed with depression. After at least 3 months of treatment with a single antidepressant, for more than half of the patients (56.6%), treatment was augmented with an atypical antipsychotic (quetiapine, risperidone, aripiprazole, or olanzapine). For the remainder (43.4%), a second antidepressant was added. The group taking antipsychotics had a 45% increased risk of dying compared with those who received a second antidepressant. Experts say these findings suggest that physicians should carefully consider whether adding antipsychotics in patients taking antidepressants outweighs the risks.

In more encouraging news, psilocybin, the psychedelic compound found in "magic mushrooms," may represent an alternative to antidepressants for some patients. Psilocybin was recently found to improve symptoms and produce remissions in patients with major depression. Results of a small randomized trial showed that psilocybin treatment was associated with a greater than 50% reduction in depressive symptoms in 67% of study participants. Although further research is needed, the potential for rapid response may make it a promising alternative to antidepressants in certain settings.

From off-label uses to new findings related to their traditional indication, antidepressants received a great deal of attention this week, becoming the top trending clinical topic.

Read more about other investigational treatments for COVID-19.


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