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Anxiety and depression in COVID-19: treatment options

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 During the examination of post-COVID patients, a direct and indirect negative effect of COVID-19 on the nervous system is found. Among the mediated subjectively significant stress factors of the pandemic, a potential long-term threat to life,  prolonged quarantine measures with selfisolation, lack of stable  immunity, restriction of access to medical services, etc. are of  particular importance.
An increased frequency of depression (up to 53.5%), anxiety (up  to 50.9%), and mixed anxiety/depressive disorders were  reported during the pandemic.
Psychopharmacotherapy in patients with COVID-19 should include drugs not only with minimally expressed undesirable effects and adverse drug interactions but also with the presence of additional therapeutic procognitive and somatotropic properties, similar to those identified in the antidepressant fluvoxamine.

About the Author

V. E. Medvedev
Department of Psychiatry, Psychotherapy, and Psychosomatic Pathology, Faculty of Advanced Training of Medical Workers, Medical Institute, Peoples' Friendship University of Russia (RUDN University)
Russian Federation

 6, Miklukho-Maklai St., Moscow 117198, Russia 


1. Al-Samkari H, Leaf RK, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood. 2020 Jul 23;136(4):489-500. doi: 10.1182/blood.2020006520

2. Amraei R, Rahimi N. COVID-19, Renin-Angiotensin System and Endothelial Dysfunction. Cells. 2020 Jul 9;9(7):1652. doi: 10.3390/cells9071652

3. Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020 Dec;196:382-94. doi: 10.1016/j.thromres.2020.09.027. Epub 2020 Sep 24.

4. Chana-Cuevas P, Salles-Gandara P, Rojas-Fernandez A, et al. The Potential Role of SARS-COV-2 in the Pathogenesis of Parkinson's Disease. Front Neurol. 2020 Sep 17;11:1044. doi: 10.3389/fneur.2020.01044. eCollection 2020.

5. Nanda S, Handa R, Prasad A, et al. Covid-19 associated Guillain-Barre Syndrome: Contrasting tale of four patients from a tertiary care cent-re in India. Am J Emerg Med. 2020;S0735-6757(20)30823-8. doi: 10.1016/j.ajem.2020.09.029

6. Goldberg JF. Psychiatry’s niche role in the COVIDE19 pandemic. J Clin Psychiatry. 2020 Apr 7;81(3):20com13363. doi: 10.4088/JCP.20com13363

7. Yao H, Chen JH, Xu YF. Patients with mental health disorders in the COVID-19 epidemic. Lancet Psychiatry. 2020 Apr;7(4):e21. doi: 10.1016/S2215-0366(20)30090-0

8. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020 Mar 28;395(10229):1033-4. doi: 10.1016/S0140-6736(20)30628-0.

9. Epub 2020 Mar 16.

10. Medvedev VE, Korovyakova EA, Frolova VI, Gushanskaya EV. Antidepressant therapy in patients with cardiovascular diseases. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(1):131-40. doi: 10.14412/2074-2711-2019-1-131-140 (In Russ.).

11. Steptoe A, Shankar A, Demakakos P, et al. Social isolation, loneliness, and all cause mortality in older men and women. Proc Natl Acad Sci USA. 2013 Apr 9;110(15):5797-801. doi: 10.1073/pnas.1219686110. Epub 2013 Mar 25.

12. Medvedev VE, Dogotar OA. COVID-19 and mental health: challenges and first conclusions. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):4-10. doi: 10.14412/2074-2711-2020-6-4-10 (In Russ.).

13. Brooks SK, Webster RK, Smith LE, et al. The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence. Lancet. 2020 Mar 14;395(10227):912-20. doi: 10.1016/S0140-6736(20)30460-8. Epub 2020 Feb 26.

14. Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, et al. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad Saude Publica. 2020 Apr 30;36(4):e00054020. doi: 10.1590/0102-311X00054020. eCollection 2020.

15. Panchal N. The Implications of COVID-19 for Mental Health and Substance Use. KFF; 2020.

16. Dong L, Bouey J. Public Mental Health Crisis during COVID-19 Pandemic, China. Emerg Infect Dis. 2020 Jul;26(7):1616-8. doi: 10.3201/eid2607.200407. Epub 2020 Jun 21.

17. Choi EH, Hui BH, Wan EF. Depression and Anxiety in Hong Kong during COVID-19. Int J Environ Res Public Health. 2020 May 25;17(10):3740. doi: 10.3390/ijerph17103740

18. Stein MB. COVID-19 and Anxiety and Depression in 2020. Depress Anxiety. 2020 Apr;37(4):302. doi: 10.1002/da.23014

19. Yang Y, Li W, Zhang Q, et al. Mental health services for older adults in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e19. doi: 10.1016/S2215-0366(20)30079-1. Epub 2020 Feb 19.

20. Novel coronavirus (2019-nCoV): strategic preparedness and response plan Feb 3, 2020. World Health Organization, 2019 [cited 2020 Feb 7]. Available from:

21. defaultsource/coronaviruse/srp-04022020.pdf

22. World Health Organization. Mental Health and Psychosocial Considerations During COVID-19 Outbreak. 2020: Available from:

23. Bueno-Notivol J, Gracia-Garcia P, Olaya B, et al. Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies. Int J Clin Health Psychol. 2020 Jan-Apr;21(1):100196. doi: 10.1016/j.ijchp.2020.07.007. Epub 2020 Aug 31.

24. Schwartz BJ. New APA survey on public anxiety over COVIDE19. High Anxiety in America Over COVID-19. Medscape. Mar 28, 2020.

25. Yesilkaya UH, Balcioglu YH, Sahin S. Reissuing the sigma receptors forSARS-CoV-2. J Clin Neurosci. 2020 Oct;80:72-3. doi: 10.1016/j.jocn.2020.08.014. Epub 2020 Aug 11.

26. Petrova NN, Morozov PV, Markin AV, et al. The COVID-19 pandemic: challenges of our times, with discussion on the latest data regarding an issue of rational psychopharmacotherapy choices in patients with SARS-CoV-2 infection. Psikhiatriya i psikhofarmakoterapiya. 2020;(6):8-24 (In Russ.).

27. Mosolov SN. Psychiatric Services Strategies During the COVID-19 Pandemic. Sovremennaya terapiya psikhicheskikh rasstroystv. 2020;(2):26-32. doi: 10.21265/PSYPH.2020.53.59536 (In Russ.).

28. American Psychiatric Association (APA). Telepsychiatry Practice Guidelines. Epub April 23 2020. Available from:

29. Doarn CR. Telemedicine and psychiatry: a natural match. mHealth. 2018 Dec 19;4:60. doi: 10.21037/mhealth.2018.12.04. eCollection 2018.

30. Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020 Apr;7(4):300-2. doi: 10.1016/S2215-0366(20)30073-0. Epub 2020 Feb 19.

31. Liu S, Yang L, Zhang C, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020 Apr;7(4):e17-e18. doi: 10.1016/S2215-0366(20)30077-8. Epub 2020 Feb 19.

32. South AM, Diz DI, Chappell MC. COVID-19, ACE2, and the cardiovascular consequences. Am J Physiol Heart Circ Physiol. 2020 May 1;318(5):H1084-H1090. doi: 10.1152/ajpheart.00217.2020. Epub 2020 Mar 31.

33. Medvedev VE. Afobazol in treatment of anxiety and mixed anxiety and depressive disorders in patients with cardiovascular diseases. Psikhiatriya i psikhofarmakoterapiya im. P.B. Gannushkina. 2015;(5-6):34-41 (In Russ.).

34. Medvedev VE. Pregabalin in neuropsychiatric practice: anxiety, pain, epilepsy. Meditsinskiy al'manakh. 2017;5(50):62-4 (In Russ.).

35. Medvedev VE. Efficacy and tolerability of contemporary antidepressants: results of network meta-analyses and Russian experience. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2018;118(11):109-17. doi: 10.17116/jnevro2018118111109 (In Russ.).

36. Medvedev VE, Ter-Israyelyan AYu, Frolova VI, et al. Optimization of the treatment of mental disorders with a multisyndromic clinical picture. Psikhiatriya i psikhofarmakoterapiya. 2020;(1):23-7 (In Russ.).

37. Medvedev VE, Frolova VI, Ter-Israyelyan AYu, et al. Treatment of depressive disorders with circannual rhythm. Psikhiatriya i psikhofarmakoterapiya. 2018;20(5):38-43 (In Russ.).

38. Usov GM. Pharmacotherapy of obsessivecompulsive disorder: a focus on fluvoxamine (literature review). Psikhiatriya i psikhofarmakoterapiya. 2020;(4):7-13 (In Russ.).

39. Medvedev VE. Sigma receptors: their role in the treatment of affective disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;4(2):105-7. doi: 10.14412/2074-2711-2012-395 (In Russ.).

40. Narita N, Hashimoto K, Tomitaka S, Minabe Y. Interactions of selective serotonin reuptake inhibitors with subtypes of sigma receptors in rat brain. Eur J Pharmacol. 1996 Jun 20;307(1):117-9. doi: 10.1016/0014-2999(96)00254-3

41. Albayrak Y, Hashimoto K. Sigma-1 Receptor Agonists and Their Clinical Implications in Neuropsychiatric Disorders. Adv Exp Med Biol. 2017;964:153-61. doi: 10.1007/978-3-319-50174-1_11

42. Rosen DA, Seki SM, Fernandez-Castaneda A, et al. Modulation of the sigma-1 receptor-IRE1 pathway is beneficial in preclinical models of inflammation and sepsis. Sci Transl Med. 2019 Feb 6;11(478):eaau5266. doi: 10.1126/scitranslmed.aau5266

43. Schön MP, Berking C, Biedermann T, et al. COVID-19 and immunological regulations – from basic and translational aspects to clinical implications. J Dtsch Dermatol Ges. 2020 Aug;18(8):795-807. doi: 10.1111/ddg.14169. Epub 2020 Aug 6.

44. Anderson G, Reiter RJ. Melatonin: Roles in influenza, Covid-19, and otherviral infections. Rev Med Virol. 2020 May;30(3):e2109. doi: 10.1002/rmv.2109. Epub 2020 Apr 21.

45. Gimenez VM, Inserra F, Tajer CD, et al. Lungs as target of COVID-19 in-fection: Protective common molecular mechanisms of vitamin D and melatonin as a new potential synergistic treatment. Life Sci. 2020 Aug 1;254:117808. doi: 10.1016/j.lfs.2020.117808. Epub 2020 May 15.

46. Härtter S, Grözinger M, Weigmann H, et al. Increased bioavailability of oral melatonin after fluvoxamine coadministration. Clin Pharmacol Ther. 2000 Jan;67(1):1-6. doi: 10.1067/mcp.2000.104071

47. Öztürk G, Akbulut KG, Güney S. Melatonin, aging, and COVID-19: Could melatonin be beneficial for COVID-19 treatment in the elderly? Turk J Med Sci. 2020 Oct 22;50(6):1504-12. doi: 10.3906/sag-2005-356

48. Medvedev VE. Fluvoxamine (Luvox) in the treatment of disorders obsessive-compulsive spectrum. Zhurnal psikhiatrii i psikhofarmakoterapii. 2015;(1):44-9 (In Russ.).

49. Garcia IG, Rodriguez-Rubio M, Mariblanca AR, et al. A randomized multicenter clinical trial to evaluate the efficacy of melatonin in the prophylaxis of SARS-CoV-2 infection in high-risk contacts (MeCOVID Trial): Astructured summary of a study protocol for a randomised controlled trial. Trials. 2020 Jun 3;21(1):466. doi: 10.1186/s13063-020-04436-6

50. Härtter S, Wang X, Weigmann H, et al. Differential effects of fluvoxamine and other antidepressants on the biotransformation of melatonin. J Clin Psychopharmacol. 2001 Apr;21(2):167-74. doi: 10.1097/00004714-200104000-00008

51. Von Bahr C, Ursing C, Yasui N, et al. Fluvoxamine but not citalopram increases serum melatonin in healthy subjects – an indication that cytochrome P450 CYP1A2 and CYP2C19 hydroxylate melatonin. Eur J Clin Pharmacol. 2000 May;56(2):123-7. doi: 10.1007/s002280050729

52. Hindmarch I, Hashimoto K. Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered. Hum Psychopharmacol Clin Exp. 2010 Apr;25(3):193-200. doi: 10.1002/hup.1106

53. Stahl StM. Stahl's Essential Psychopharmacology (Neuroscientific Basis and Practical Application). 4th ed. Cambridge University Press; 2013.

54. Zhang R, Wang X, Ni L, et al. COVID-19: Melatonin as a potential adjuvant treatment. Life Sci. 2020 Jun 1;250:117583. doi: 10.1016/j.lfs.2020.117583. Epub 2020 Mar 23.

55. Medvedev VE, Frolova VI, Yepifanov AV. New possibilities of pharmacotherapy in cardiovascular patients with mental disorders. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2014;(9):30-7 (In Russ.).

56. Medvedev VE, Chobanu IK, Frolova VI, et al. Efficiency of psychopharmacotherapy and psychotherapy in patients with cardiovascular diseases. Arkhiv" vnutrenney meditsiny. 2013;(5):61-6. (In Russ.).

57. Lekakis J, Ikonomidis I, Papoutsi Z, et al. Selective serotonin re-uptake inhibitors decrease the cytokine-induced endothelial adhesion molecule expression, the endothelial adhesiveness to monocytes and the circulating levels of vascular adhesion molecules. Int J Cardiol. 2010 Mar 4;139(2):150-8. doi: 10.1016/j.ijcard.2008.10.010. Epub 2008 Nov 11.

58. Medvedev VE. Therapy of anxiety-depressive disorders in patients with a therapeutic profile. Psikhiatriya i psikhofarmakoterapiya. 2015;(1):21-30 (In Russ.).

59. Laird LK, Lydiard RB, Morton WA, et al. Cardiovascular effects of imipramine, fluvoxamine, and placebo in depressed outpatients. J Clin Psychiatry. 1993 Jun;54(6):224-8.

60. Wakelin JS. Fluvoxamine in the treatment of the older depressed patient; double-blind, placebo-controlled data. Int Clin Psychopharmacol. 1986 Jul;1(3):221-30. doi: 10.1097/00004850-198607000-00005

61. Ohtani H, Odagiri Y, Sato H, et al. A Comparative Pharmacodynamic Study of the Arrhythmogenicity of Antidepressants, Fluvoxamine and Imipramine. Biol Pharm Bull. 2001 May;24(5):550-4. doi: 10.1248/bpb.24.550

62. Otsubo T, Akimoto Y, Yamada H, et al. A comparative study of the efficacy and safety profiles between fluvoxamine and nortriptyline in Japanese patients with major depression. Pharmacopsychiatry. 2005 Jan;38(1):30-5. doi: 10.1055/s-2005-837769

63. Rechlin T. The effect of amitriptyline, doxepin, fluvoxamine, and paroxetine treatment on heart rate variability. J Clin Psychopharmacol. 1994 Dec;14(6):392-5. doi: 10.1097/00004714-199412000-00004

64. Pragen J. The Cardiotropic Effect of Antidepressants. А Comparison with Fluvoxamine. Adv Pharmacother. 1986;2:133-50.

65. Nemeroff ChB, Ninan PhT, Ballenger J, et al. Double-blind multicenter comparison of fluvoxamine versus sertraline in the treatment of depressed outpatients. J Depres. 1995;3:163-9. doi: 10.1002/depr.3050030402


For citations:

Medvedev V.E. Anxiety and depression in COVID-19: treatment options. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(2):111-116. (In Russ.)

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ISSN 2074-2711 (Print)
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