{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T04:31:52Z","timestamp":1771907512306,"version":"3.50.1"},"reference-count":153,"publisher":"Georg Thieme Verlag KG","issue":"01\/02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Fortschr Neurol Psychiatr"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title>\n                  <jats:p>Einleitung Pr\u00e4klinisch zeigten Fluvoxamin und andere Antidepressiva (AD)\n                    antivirale und anti-inflammatorische Eigenschaften auch gegen SARS-COV-2. Daher\n                    liegt es nahe, die klinische Wirksamkeit von AD gegen COVID-19 und Long COVID zu\n                    testen.<\/jats:p>\n                  <jats:p>Methodik Am 20.05.2024 identifizierte dieses systematische Scoping Review\n                    in PUBMED 1016 Artikel, die sich auf AD und COVID-19, Long COVID und SARS-COV-2\n                    bezogen. Darunter waren 10 retrospektive \u201eLarge Scale\u201c Studien (&gt; 20000\n                    Chart-Reviews), 8 prospektive klinische Studien (plus 4 bez\u00fcglich Long COVID),\n                    11 Placebo-kontrollierte randomisierte (RCT) (plus 2 bez\u00fcglich Long COVID) und\n                    15 Meta-Analysen.<\/jats:p>\n                  <jats:p>Resultate COVID-19: Retrospektive Studien mit Kohorten, die meistens AD\n                    wegen psychiatrischer Komorbidit\u00e4ten oder chronischer Schmerzerkrankungen schon\n                    vor der SARS-COV-2 Infektion einnahmen, beschrieben dass diese Substanzklasse\n                    (am meisten untersucht: Selektive Serotonin Re-Uptake Hemmer (SSRI) und\n                    Selektive Serotonin Noradrenalin Re-Uptake Hemmer (SSNRI)) (i) mit signifikant\n                    weniger SARS-COV-2-Infektionen und (ii) mit einem leichter verlaufenden COVID-19\n                    (\u201eCOVID-19-Protektion\u201c) assoziiert waren. Zehn der 11 bez\u00fcglich COVID-19\n                    gefunden RCT pr\u00fcften Fluvoxamin, da dieses \u00e4ltere AD prophylaktisch gegen ein\n                    schweres COVID-19 geeignet erschien unter Ber\u00fccksichtigung seiner in vitro\n                    Potenz gegen intrazellul\u00e4re Sepsis-Kaskaden. Deshalb bezogen sich auch die\n                    meisten (12 von 15) Meta-Analysen auf Fluvoxamin. Sie fanden (i) eine\n                    signifikante (meistens 40-70%ige Reduktion) von Mortalit\u00e4ts-, Intubations- und\n                    Hospitalisierungs-Raten, wenn Fluvoxamin als add-on zur Standardtherapie bei\n                    mildem bis moderatem COVID-19 eingesetzt wurde. Schon im fr\u00fchem\n                    Krankheitsstadium gegeben war das AD erfolgreicher als wenn es erst sp\u00e4ter bei\n                    fortgeschrittenem, schweren COVID-19 (z.B. Pneumonie, Sepsis) eingesetzt wurde.\n                    Weiterhin fiel eine Dosisabh\u00e4ngigkeit auf: 2x50 mg Fluvoxamin \u00fcber 15 Tage waren\n                    weniger wirksam als 2x100 oder gar 3x100 mg bei einer Nebenwirkungsrate\n                    weiterhin auf dem Placebo-Niveau. Direkte Vergleiche mit gegen COVID-19\n                    zugelassen Medikamenten existieren bisher nicht. Ein erster indirekter\n                    meta-analytischer Vergleich zeigte einen Vorteil von Paxlovid oder Molnupiravir\n                    versus Fluvoxamin gegen schwere COVID-19 Verl\u00e4ufe: Risiko-Reduktion um 95% (I2 =\n                    N\/A, allerdings nur eine Studie) oder 78% (I2=0) versus 55% (I2=48). Ein add-on\n                    von Fluvoxamin war aber immer noch signifikant wirksamer als die\n                    symptomorientierte Standardtherapie alleine. Long COVID: Ein h\u00e4ufiger Long COVID\n                    Ph\u00e4notyp mit dominierenden Angst- und Depressions-Symptomen, der insbesondere\n                    auf AD, Entspannungsma\u00dfnahmen und\/oder Psychotherapie positiv reagiert, ist\n                    inzwischen identifiziert worden. Kasuistiken beschreiben positive Einfl\u00fcsse von\n                    AD auf Fatigue, kognitive und autonome Dysfunktionen. Eine erste gro\u00dfe\n                    prospektive Open-Label RCT (N=995) zeigte soeben signifikant mehr g\u00fcnstige\n                    Verl\u00e4ufe, weniger Virus-Last, weniger pro-inflammatorische Cytokine bei der\n                    Behandlung von mildem bis moderatem COVID-19 mit Fluvoxamin versus\n                    Standard-Behandlung, auch bez\u00fcglich der sp\u00e4teren Entwicklung von\n                    neuropsychiatrischem und pulmonalem Long COVID oder Fatigue.<\/jats:p>\n                  <jats:p>Schlussfolgerung Insgesamt gibt es vielversprechende Hinweise auf eine\n                    pr\u00e4ventive Wirkung vom AD (insbesondere Fluvoxamin) gegen einen schweren\n                    COVID-19 Verlauf und gegen die Entwicklung von Long COVID. Die M\u00f6glichkeit, dass\n                    die gesamte Substanzkasse der AD hier effektiv sein k\u00f6nnte wird anhand der\n                    Ergebnisse retrospektiver Large Scale Studien wahrscheinlich, wartet aber auf\n                    eine \u00dcberpr\u00fcfung durch besser kontrollierte Studien. Die potentielle Wirksamkeit\n                    (aktuell geringe beziehungsweise moderate Vertrauensw\u00fcrdigkeit der Evidenz f\u00fcr\n                    die ganze Substanzklasse bzw. speziell Fluvoxamin) von AD als add-on gegen\n                    COVID-19 und gegebenenfalls direkt auch gegen Long COVID k\u00f6nnte \u00e4hnliche\n                    Projekte bei anderen Infektionserkrankungen stimulieren, die ebenfalls das\n                    Potential haben, die Gesundheit der Betroffenen nachhaltig zu schw\u00e4chen. Wir\n                    meinen, dass die bisherigen Befunde ausreichen, um bei der Psychoedukation von\n                    Patienten mit COVID-19 oder Long COVID, die wegen anderer Erkrankungen AD\n                    erhalten, eine potentiell positive Wirkung dieser Substanzen - auch gerade gegen\n                    die mit der Viruserkrankung oder dessen Folgen verbundenen Beschwerden \u2013\n                    hervorheben zu k\u00f6nnen. In Regionen, die weder Impfungen noch antivirale\n                    Substanzen vorhalten k\u00f6nnen, die aktuell zur Pr\u00e4vention oder Behandlung von\n                    COVID-19 zugelassen sind, w\u00e4ren AD und insbesondere Fluvoxamin eine\n                    kosteng\u00fcnstige Alternative zum Schutz vor einem schweren Verlauf, obwohl dieses\n                    AD schw\u00e4cher gegen COVID-19 zu wirken scheint als die aktuell zugelassenen\n                    antiviralen Substanzen, jedoch bei mutma\u00dflich besserer Vertr\u00e4glichkeit. Eine\n                    direkte vergleichende klinische Studie mit zugelassenen antiviralen Wirkstoffen\n                    steht noch aus und sollte positiv ausfallen, um die T\u00fcr f\u00fcr eine\n                    leitliniengest\u00fctzte Empfehlung von Fluvoxamin (oder AD) f\u00fcr COVID-19 oder dessen\n                    Folgeerscheinungen noch weiter zu \u00f6ffnen.<\/jats:p>","DOI":"10.1055\/a-2374-2218","type":"journal-article","created":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T19:13:56Z","timestamp":1727118836000},"page":"14-33","source":"Crossref","is-referenced-by-count":4,"title":["Die Bedeutung von Antidepressiva bei COVID-19 und Long-COVID \u2013 Ein\n                    Scoping-Review Update"],"prefix":"10.1055","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-8337","authenticated-orcid":false,"given":"Udo","family":"Bonnet","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Seelische Gesundheit, Akademisches Lehrkrankenhaus der\n                    Universit\u00e4t Duisburg-Essen, Evangelisches Krankenhaus Castrop-Rauxel,\n                    Castrop-Rauxel, Germany"},{"name":"LVR-Universit\u00e4tsklinikum Essen, Klinik f\u00fcr Psychiatrie und\n                    Psychotherapie, Medizinische Fakult\u00e4t, Universit\u00e4t Duisburg-Essen, Essen,\n                    Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Georg","family":"Juckel","sequence":"additional","affiliation":[{"name":"LWL-Universit\u00e4tsklinikum der Ruhr-Universit\u00e4t Bochum, Klinik f\u00fcr\n                    Psychiatrie, Psychotherapie und Pr\u00e4ventivmedizin, Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,9,23]]},"reference":[{"key":"ref3","doi-asserted-by":"publisher","first-page":"e247395","DOI":"10.1001\/jama.2024.7395","article-title":"Mortality in Patients Hospitalized for COVID-19 vs Influenza in 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