Preexisting Mood Disorder Influences COVID-19 Outcomes

The outcomes of many medical disorders are worse in individuals with a history of mood disorders. This interaction can occur for a variety of reasons ranging from the influence of mood disorders on the immune system to impacts on self-care. In a paper recently published in the American Journal of Psychiatry, Victor Castro and colleagues examined the possible influence of a history of mood disorders on outcomes of hospitalized persons testing positive for SARS-CoV-2, the virus responsible for COVID-19.

The research group conducted a retrospective study of electronic health records of 2,988 patients admitted to six hospitals in eastern Massachusetts for treatment of COVID-19 between February 15 and May 24, 2020. Twenty-four percent (717) of these patients had a history of mood disorder documented in their medical charts. Information regarding concurrent mood disorder during admission for COVID-19 wasn’t presented in the paper.

Of the nearly 3,000 patients studied, 459 (15.4%) died. Of the survivors, about 54.5% were discharged to either a rehabilitation facility or skilled nursing facility, and the remaining 45.5% were able to return home.

Did a prior history of mood disorders influence the outcomes of these individuals? Of the 717 patients with a history of mood disorders, 137 (19%) died while in the hospital. Of the survivors, 66% were discharged to a rehabilitation center or skilled nursing facility. These numbers are more than 30% higher than those without a history of mood disorder. The rates of death or being discharged to another facility remained substantially higher for those with a history of mood disorders even after controlling for other possible confounding variables, including age, sex, race, ethnicity, comorbid illnesses, and sociodemographic variables.

Interestingly, the rate of death during the first 11 days of hospitalization was no different for those with and without a history of mood disorders. The divergence in death rates was not observed until day 12 and beyond.

Why is a history of mood disorders associated with greater mortality and morbidity in patients suffering from COVID-19? These questions cannot be answered from this study. However, the authors suggest several possibilities. Mood disorders are associated with altered immune and inflammatory responses, which could increase mortality and morbidity resulting from COVID-19. It is also possible that effects of COVID-19 on the brain (either direct effects, effects on blood flow to the brain, or inflammatory effects) could interact with abnormalities in brain function associated with mood disorders.

The authors do not provide data regarding the use of antidepressants in the patients with a history of mood disorder. Preliminary research suggests that treatment with fluvoxamine, an SSRI antidepressant, may decrease the severity of COVID-19 symptoms. It would be interesting to know if the patients in this study who had a history of depression and were currently taking an antidepressant had better outcomes than those not taking antidepressants.

Clinicians should be alert to the possibility that a person with a history of a mood disorder may have more difficulty fighting the sequelae of COVID-19. Such knowledge may alter interventions. Once the mechanisms underlying this relationship are clarified, specific treatments may be implemented.

This post was written by Eugene Rubin MD, Ph.D. and Charles Zorumski MD.