Antidepressant for Covid.

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The fluvoxamine trial formed part of the larger TOGETHER Trial that started in May 2020, aiming to test potential COVID-19 treatments in a community setting.

TOGETHER Trial scientists tested eight drugs, including hydroxychloroquine, metformin, kaletra and ivermectin, but only fluvoxamine had a positive effect on COVID-19.

“Fluvoxamine is the only treatment that, if administered early, can prevent COVID-19 from becoming a life-threatening illness,” said Mills, co-principal investigator for the TOGETHER Trial and a professor of McMaster’s Department of Health Research Methods, Evidence, and Impact. “It could be one of our most powerful weapons against the virus and its effectiveness is one of the most important discoveries we have made since the pandemic began.

“In addition, this cheap, easily-accessible pill is a massive boon to public health, both in Canada and internationally, allowing hospitals to avoid expensive and sometimes risky treatments.”

Costing about $4 per 10-day course, fluvoxamine could be a game-changer for poorer countries with low vaccination rates and lacking access to more advanced COVID-19 therapies, Mills said.

So the rich get richer, and the sick get happy pills?

Watson tells The Scientist that one effect of the new fluvoxamine study has been to encourage other trial organizers to include SSRIs in their own studies, noting a trial he is involved with in sub-Saharan Africa as an example. “You get this positive result and then it becomes this new fashion and then all the trials want to try it out,” he says. While he supports the idea of a larger trial of fluvoxamine, for now, he says, “I definitely think this does not support changing [treatment] guidelines.”Reiersen and Lenze express a different view, saying that they want to see fluvoxamine being prescribed as a COVID-19 treatment based on current evidence. Lenze, who calls the drug “life-saving” in an email to The Scientist, notes that fluvoxamine is easy to take and has a good safety record. “Doctors can prescribe it now to reduce their patients’ risk of hospitalization and death,” he says.

“I think based on the current evidence it makes sense for physicians to go ahead and prescribe fluvoxamine for certain high risk outpatients with symptomatic COVID-19, after considering the current evidence, any potential drug interactions, and the risks & benefits specific to their patients,” agrees Reiersen, who has previously also voiced her support for the use of ivermectin, an antiparasitic drug that has yet to show efficacy against COVID-19 in well-controlled randomized clinical trials.

See “Ivermectin (Still) Lacks Support as a COVID-19 Drug”
“I look forward to seeing whether [the National Institutes of Health] adjusts their guidelines to support this,” she says of fluvoxamine, adding that she is currently collaborating with researchers at various institutions to work toward clarifying its mechanisms of action in lab studies. There could be other benefits of the drug, she suggests: “I also hope to start a randomized controlled trial using fluvoxamine to treat long COVID.”