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Javelot H, Straczek C, Meyer G, Gitahy Falcao Faria C, Weiner L, Drapier D, Fakra E, Fossati P, Weibel S, Dizet S, Langrée B, Masson M, Gaillard R, Leboyer M, Llorca PM, Hingray C, Haffen E, Yrondi A. Psychotropics and COVID-19: An analysis of safety and prophylaxis. L'ENCEPHALE 2021; 47:564-588. [PMID: 34548153 PMCID: PMC8410507 DOI: 10.1016/j.encep.2021.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/19/2021] [Indexed: 12/15/2022]
Abstract
The use of psychotropics during the COVID-19 pandemic has raised two questions, in order of importance: first, what changes should be made to pharmacological treatments prescribed to mental health patients? Secondly, are there any positive side effects of these substances against SARS-CoV-2? Our aim was to analyze usage safety of psychotropics during COVID-19; therefore, herein, we have studied: (i) the risk of symptomatic complications of COVID-19 associated with the use of these drugs, notably central nervous system activity depression, QTc interval enlargement and infectious and thromboembolic complications; (ii) the risk of mistaking the iatrogenic impact of psychotropics with COVID-19 symptoms, causing diagnostic error. Moreover, we provided a summary of the different information available today for these risks, categorized by mental health disorder, for the following: schizophrenia, bipolar disorder, anxiety disorder, ADHD, sleep disorders and suicidal risk. The matter of psychoactive substance use during the pandemic is also analyzed in this paper, and guideline websites and publications for psychotropic treatments in the context of COVID-19 are referenced during the text, so that changes on those guidelines and eventual interaction between psychotropics and COVID-19 treatment medication can be reported and studied. Finally, we also provide a literature review of the latest known antiviral properties of psychotropics against SARS-CoV-2 as complementary information.
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Affiliation(s)
- H Javelot
- Établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, centre de recherche en biomédecine de Strasbourg, université de Strasbourg, 1, rue Eugène-Boeckel, 67000 Strasbourg, France.
| | - C Straczek
- Département de pharmacie, CHU d'Henri-Mondor, université Paris Est Créteil (UPEC), AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France; Inserm U955, institut Mondor de recherche biomédical, neuropsychiatrie translationnelle, 8, rue du Général-Sarrail, 94000 Créteil, France
| | - G Meyer
- Service pharmacie, établissement public de santé Alsace Nord, 141, avenue Strasbourg, 67170 Brumath, France; Service pharmacie, CHU de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - C Gitahy Falcao Faria
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), avenue Pedro-Calmon, 550 - Cidade Universitária da Universidade Federal do Rio de Janeiro, 21941-901 Rio de Janeiro, Brazil
| | - L Weiner
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - D Drapier
- Pôle hospitalo-universitaire de psychiatrie adulte, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; EA 4712, comportements et noyaux gris centraux, université de Rennes 1, 2, avenue du Professeur Léon-Bernard, CS 34317, campus santé de Villejean, 35043 Rennes cedex, France
| | - E Fakra
- Pôle universitaire de psychiatrie, CHU de Saint-Étienne, 37, rue Michelet, 42000 Saint-Étienne, France
| | - P Fossati
- Inserm U1127, ICM, service de psychiatrie adultes, groupe hospitalier pitié Salpêtrière, Sorbonne université, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Weibel
- Clinique de psychiatrie, hôpitaux universitaire de Strasbourg, 1, porte de L'Hôpital, 67000 Strasbourg, France
| | - S Dizet
- Centre de ressources et d'expertise en psychopharmacologie (CREPP) Bourgogne Franche-Comté, Chalon-sur-Saône, France; Service Pharmacie, CHS de Sevrey, 55, rue Auguste-Champio, 71100 Sevrey, France
| | - B Langrée
- Service pharmacie, centre hospitalier Guillaume-Régnier, rue du Moulin-de-Joué, 35700 Rennes, France; Clinique du Château de Garches, Nightingale Hospitals-Paris, 11, bis rue de la Porte-Jaune, 92380 Garches, France
| | - M Masson
- SHU, GHU psychiatrie et neurosciences, 1, rue Cabanis, 75014 Paris, France; GHU psychiatrie et neurosciences, université de Paris, Paris, France
| | - R Gaillard
- Conseil national des universités (CNU), 1, rue Cabanis, 75014 Paris, France
| | - M Leboyer
- Inserm, DMU IMPACT, IMRB, translational neuropsychiatry, fondation FondaMental, hôpitaux universitaires « H. Mondor », université Paris Est Créteil (UPEC), AP-HP, 40, rue de Mesly, 94000 Créteil, France; CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - P M Llorca
- Université Clermont-Auvergne, 1, rue Lucie- et Raymond-Aubrac, 63100 Clermont-Ferrand, France; Pôle hospitalo-universitaire de psychiatrie d'adultes du Grand Nancy, centre psychothérapique de Nancy, 1, rue Docteur Archambault, 54520 Laxou, France
| | - C Hingray
- Département de neurologie, CHU de Nancy, 25, rue Lionnois, 54000 Nancy, France; CIC-1431 Inserm, service de psychiatrie, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - E Haffen
- Laboratoire de neurosciences, université de Franche-Comté, 19, rue Ambroise-Paré, 25030 Besançon cedex, France
| | - A Yrondi
- Unité ToNIC, UMR 1214 CHU Purpan-Pavillon Baudot, place du Dr Joseph Baylac, 31024 Toulouse cedex 3, France
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Javelot H, Petrignet J, Addiego F, Briet J, Solis M, El-Hage W, Hingray C, Weiner L. Towards a pharmacochemical hypothesis of the prophylaxis of SARS-CoV-2 by psychoactive substances. Med Hypotheses 2020; 144:110025. [PMID: 33254478 PMCID: PMC7309834 DOI: 10.1016/j.mehy.2020.110025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022]
Abstract
An increasing body of evidence suggests a protective effect of some psychoactive substances against SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus type 2). Recent findings suggest that patients with psychiatric disorders are less affected by SARS-CoV-2 than their caregivers, which may seem surprising given some of the frequent risk factors for an unfavorable course of the disease (e.g., obesity, diabetes, cardiovascular and pulmonary diseases). We propose here a mixed pharmacoepidemiological and pharmacochemical hypothesis to explain these findings. A number of psychotropic drugs exhibit activities against coronaviruses (Middle East Respiratory Syndrome coronavirus (MERS-CoV), the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV-1) and the Infectious Bronchitis Virus (IBV)) and have been put forward as potentially anti-SARS-CoV-2. These treatments include numerous mee-too drugs (chemically and pharmacologically linked to those which have demonstrated anti-SARS-CoV-2 efficacy) which are frequently prescribed in psychiatric settings. Taken alone or in polypharmacy, these drugs could have a prophylactic anti-SARS-CoV-2 effect, explaining the unexpectedly low proportion of patients with psychiatric disorders and COVID-19. Associated factors such as nicotine can also be considered in the context of a broad chemoprophylactic hypothesis in patients with psychiatric disorders taking different psychoactive substances.
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Affiliation(s)
- Hervé Javelot
- Etablissement Public de Santé Alsace Nord, Brumath, France; Laboratoire de Toxicologie et Pharmacologie Neuro Cardiovasculaire, Université de Strasbourg, Strasbourg, France.
| | - Julien Petrignet
- Laboratoire Synthèse et Isolement de Molécules BioActives (SIMBA, EA 7502), Université de Tours, Faculté des Sciences et Techniques, Tours, France
| | - Frédéric Addiego
- Luxembourg Institute of Science and Technology (LIST), Department Materials Research and Technology (MRT), Hautcharage, Luxembourg
| | - Jeanne Briet
- Service Pharmacie, Centre Hospitalier de Montceau, Montceau-les-Mines, France
| | - Morgane Solis
- Hôpitaux universitaires de Strasbourg, Laboratoire de virologie, Strasbourg, France; Université de Strasbourg, Inserm, UMR-S 1109, Strasbourg, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, CHRU de Tours, INSERM, Tours, France; Centre Expert Dépression Résistante, Fondation FondaMental, Tours, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France; CHU de Nancy, Département de Neurologie, Nancy, France
| | - Luisa Weiner
- Pôle de Psychiatrie, Santé Mentale et Addictologie, Hôpitaux Universitaires de Strasbourg, France; Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
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Javelot H, Weiner L, Petrignet J, Meyer G, Briet J, El-Hage W, Hingray C. Psychoactive compounds as multifactorial protection factors against COVID-19. Ir J Med Sci 2020; 190:849-850. [PMID: 32812114 PMCID: PMC7433988 DOI: 10.1007/s11845-020-02346-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Hervé Javelot
- Établissement Public de Santé Alsace Nord, Brumath, France.
- Laboratoire de Toxicologie et Pharmacologie Neuro Cardiovasculaire, Université de Strasbourg, Strasbourg, France.
| | - Luisa Weiner
- Clinique de Psychiatrie, CHU de Strasbourg, Strasbourg, France
- Laboratoire de Psychologie des Cognitions, Université de Strasbourg, Strasbourg, France
| | - Julien Petrignet
- Laboratoire Synthèse et Isolement de Molécules BioActives (SIMBA, EA 7502), , Faculté des Sciences et Techniques, Université de Tours, Tours, France
| | - Guillaume Meyer
- Service Pharmacie, Établissement Public de Santé Alsace Nord, Brumath, France
- Service Pharmacie, CHU de de Strasbourg, Strasbourg, France
| | - Jeanne Briet
- Service Pharmacie, Centre Hospitalier de Montceau, Montceau-les-Mines, France
| | - Wissam El-Hage
- UMR 1253, iBrain, Université de Tours, CHRU de Tours, INSERM, Tours, France
- Centre Expert Dépression Résistante, Fondation FondaMental, Tours, France
| | - Coraline Hingray
- Pôle Hospitalo-Universitaire de Psychiatrie d'Adultes du Grand Nancy, Centre Psychothérapique de Nancy, Laxou, France
- Département de Neurologie, CHU de Nancy, Nancy, France
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Javelot H, Weiner L. [Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic]. L'ENCEPHALE 2020; 46:S93-S98. [PMID: 32507556 PMCID: PMC7241353 DOI: 10.1016/j.encep.2020.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022]
Abstract
Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).
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Affiliation(s)
- H Javelot
- Établissement Public de Santé Alsace Nord (EPSAN), Brumath, France; Laboratoire de toxicologie et pharmacologie neurocardiovasculaire, université de Strasbourg, Strasbourg, France.
| | - L Weiner
- Clinique de psychiatrie, CHU de Strasbourg, Strasbourg, France; Laboratoire de psychologie des cognitions, université de Strasbourg, Strasbourg, France
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