Long Covid & Antidepressants

Three years into this historic pandemic, the scientific and healthcare communities continue to learn a great deal regarding COVID-19, the disease that is produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most urgent and immediate focus has been on vaccine development for disease prevention/mitigation and on identification of effective therapeutic interventions for acute phase of illness. However, attention is increasingly being placed on formulating treatment strategies for individuals who are post-COVID-19 and experiencing a syndrome of persistent cognitive, somatic and behavioral symptoms that is being referred to as long COVID. In addition to identifying novel compounds that may improve outcome in either acute or residual COVID-19, an alternate and parallel strategy is to repurpose or reposition drugs which have been approved for other conditions and subsequently assess their safety and efficacy when applied to COVID-19. In this light, antidepressant medications, particularly serotonin reuptake inhibitors, have garnered attention amidst evidence supporting their anti-inflammatory and anti-viral properties. Results from several preliminary studies suggest that early administration of antidepressants may prevent clinical deterioration and even death in patients with acute COVID-19. In this article, we present purported anti-inflammatory mechanisms of the antidepressants, review results from studies that have appeared in the literature to date regarding antidepressants and acute COVID-19, and discuss the possible utility of antidepressants as a potential therapeutic resource for long COVID

Mild cognitive impairment: new neuropsychological and pharmacological target

Mild cognitive impairment (MCI) is increasingly being conceptualized in the literature as a cognitive disturbance representing a transitional phase between normal aging and dementia. The operational definitions of MCI provide an opportunity for neuropsychologists to detect subtle deficit and monitor cognitive status sequentially in order to determine rate and degree of progression. More importantly, clinical and neuropsychological studies are needed that can better characterize which MCI patients are at greatest risk for conversion to dementia. Preliminary data has also designated MCI as a potential indicator for initiation of pharmacotherapy, with the objective of decelerating rate of progression to dementia. Current criteria and clinical issues related to MCI are discussed, with the objective of better familiarizing clinicians with this syndrome and fostering ongoing investigations

Nocturnal frontal lobe epilepsy presenting as excessive daytime sleepiness

Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE

Nocturnal frontal lobe epilepsy presenting as excessive daytime sleepiness

Excessive daytime sleepiness (EDS) is common in the general population. Etiologies include insufficient sleep and primary sleep disorders. Due to its high prevalence, physicians often overlook EDS as a significant problem. However, EDS may also be the presenting symptom of seizures, in particular Nocturnal Frontal Lobe Epilepsy (NFLE). Due to the clinical similarity between the nocturnal behaviors of NFLE and parasomnias, and poor patient-related history, NFLE remains a challenging diagnosis. We report the case of a patient with NFLE who presented with a primary complaint of EDS, and discuss the differential diagnosis and evaluation of patients with EDS associated with nocturnal behaviors. In the context of a patient presenting with EDS and stereotyped nocturnal events, clinical suspicion should be high for NFLE

Alzheimer's Disease: Pharmacological Treatment and Management

The expected rise in prevalence rates of Alzheimer's disease over the next several decades has generated a great deal of attention at all levels of society, including governmental and scientific communities. These concerns have resulted in a vast number of research studies which have yielded medications focusing primarily on the symptomatic relief of the cognitive, neuropsychiatric and behavioral alterations felt to be pathognomic of the disease. Medical and pharmacological interventions which impact the onset or delay the progression of the illness are not yet readily available. We review and discuss the medications which are currently used for the symptomatic treatment and management of the disease, as well as discuss new pharmacological strategies which are under investigation and development