COVID-19: Antipsychotics may offer protection

• Antipsychotic drugs could have a protective effect against COVID-19.
• People treated with these drugs may have a lower risk of contracting the new coronavirus.
• People using these drugs may be more likely to experience a milder form of COVID-19 if they do get the virus.
• Antipsychotic drugs may reduce the activation of genes involved in inflammatory and immunological pathways associated with severe SARS-CoV-2 infections.

A group of researchers — led by scientists from the Mental Health Unit of the Virgen del Rocio University Hospital in Seville, Spain — have found that antipsychotic drugs could have a protective effect against COVID-19.

People treated with these drugs may have a lower risk of contracting the virus or may have milder symptoms if they do get the virus.

Some of the findings appear in the journal Schizophrenia Research.

“These are very interesting findings that reflect a clinical reality where we see few patients with severe COVID-19, despite the presence of various risk factors,” says Manuel Canal Rivero, a clinical psychologist and lead author of one of the two papers.

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Vulnerable group for COVID-19?

Many researchers have spent the past year studying whether or not individuals with severe mental health conditions might be more likely to contract SARS-CoV-2 and develop severe symptoms from COVID-19.

In the issue of Schizophrenia Bulletin published April 28, 2020, a team from the Centre for Addiction and Mental Health in Toronto, Canada, discussed why they believed people with schizophrenia and related disorders were likely to have a higher risk of contracting SARS-CoV-2.

They pointed to features of the condition, such as experiencing hallucinations and possessing a lower awareness of risk. They added that living in crowded settings, such as congregate housing or prisons, where social distancing is difficult, may increase the risk of contracting SARS-CoV-2.

The team wrote that they believed individuals with schizophrenia and related disorders would be more likely to have poor outcomes from COVID-19. This is because they are more likely to have poor physical health, are disadvantaged socioeconomically, and experience stigma and social isolation. Scientists believe that these factors likely elevate mortality from COVID-19.

People with severe mental illness are more likely to have conditions such as cardiovascular disease, diabetes, and chronic respiratory disease. The researchers also pointed out that people with schizophrenia are more likely to smoke, a habit that several studies have linked to developing a more severe form of COVID-19.

Another recent study published in JAMA Psychiatry reported that individuals with schizophrenia are at a significantly increased risk of dying from COVID-19.

In contrast, a South Korean study that appears in The Lancet Psychiatry found that a mental illness diagnosis has no associations with an increased likelihood of testing positive for COVID-19. The study also concluded that people with a severe mental illness had only a slightly higher risk for severe clinical outcomes from COVID-19.

Therefore, “Previous investigations to assess the prevalence of COVID-19 in [the population with severe mental health conditions] have yielded to inconsistent results,” the Seville researchers wrote.

Lower risk

For the new study, which appears in Schizophrenia Research, the research team examined data for a representative Spanish population of 557,576 adults.

Of these, 23,077 (4.1%) tested positive for COVID-19 between February and November 2020. There were 1,953 (8.5%) hospitalizations related to COVID-19 and 254 deaths (1.1%).

Among 698 people with severe mental health conditions who received treatment with long-acting injectable (LAI) antipsychotic treatment, 9 (1.3%) tested positive for COVID-19. Only one member of that group displayed COVID-19 symptoms. None had to go to the hospital, and none died due to COVID-19.

This suggests people treated with these drugs may have a lower risk of acquiring a SARS-CoV-2 infection and may be more likely to have a milder form of the disease if they do get the virus, say the researchers.

“The number of COVID-19 patients is lower than expected among this group of people, and in cases where a proven infection does occur, the evolution is benign and does not reach a life threatening clinical situation,” says Canal Rivero. “These data as a whole seem to point to the protective effect of the medication.”

The research team also points to an earlier review highlighting antipsychotics as potential treatments for Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome.

Potential COVID-19 treatment

The Seville research team also observed that “many of the genes whose expression is altered by COVID-19 are significantly down-regulated by antipsychotic drugs,” according to a press release about their work.

To make this finding, the research team investigated the gene expression profile of people with COVID-19 and the gene expression profile of people receiving treatment with antipsychotic drugs.

“In a striking way, we have shown how antipsychotics reduce the activation of genes involved in many of the inflammatory and immunological pathways associated with the severity of Covid-19 infection,” says Benedicto Crespo-Facorro, professor at the University of Seville and current director of the Mental Health Unit at the Virgen del Rocío University Hospital, both in Spain.

While Prof. Crespo-Facorro stresses that scientists must do more research, he believes the finding could be significant because it may lead to treating COVID-19 with antipsychotics.

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