Discussion
shortness of breath, taste disorder, pneumonia, fatigue, infection, psychiatric, headache, depression, smell or
TASTE DISORDER, PNEUMONIA, DISEASE, INFECTION, ADVERSE EFFECTS
In this randomized clinical trial, we found out that fluvoxamine reduces the risk of developing fatigue, the most common complaint in PCS when taken during active COVID-19. As for other PCS neuropsychological manifestations, no significant differences were observed between fluvoxamine and placebo, albeit because our primary outcome was fatigue, this trial may not have the power to discuss the effect of fluvoxamine on other post-COVID symptoms.Although fluvoxamine has been suggested for COVID-19 treatment as early as 2020, to the best of our knowledge this is the first study regarding the effects of fluvoxamine during active infection on post-COVID symptoms [In a study only on COVID-19 outpatients, 53% of COVID-positive patients had persistent symptoms. The Main reported symptoms were fatigue (32%), smell or taste disorder (22%), and headache (12%). They also noted that the prevalence of long-term symptoms was similar during 3–5, 5–7, and 7–10 months after the initial disease [There are several studies on the effect of fluvoxamine but only on COVID-19 severity during initial infection. In 2020 Lenze et al. conducted an RCT on mild COVID-19 patients receiving 300 mg/day of fluvoxamine or placebo for 15 days, evaluating clinical deterioration (shortness of breath or hospitalization for shortness of breath or pneumonia and oxygen saturation less than 92% or need for supplemental oxygen). Clinical deterioration didn’t occur in patients taking fluvoxamine and they had a lower incidence of adverse effects [It is noteworthy to mention that the effect of fluvoxamine on depression can be the result of two separate pathways. First the direct effect of fluvoxamine on serotonin levels as an SSRI, and second its probable anti-inflammatory role to prevent post-COVID psychiatric symptoms. We believe that in our study the lower prevalence of depression in patients taking fluvoxamine majorly resulted from the second pathway. The reason for this assumption is that based on the literature, fluvoxamine usually takes 4–6 weeks to effectively treat depression and the duration of the fluvoxamine regimen was 10 days in this trial [