[Recommendations about the Use of Psychotropic Medications during the COVID-19 Pandemic]

Acta Med Port. 2020 Oct 1;33(10):693-702. doi: 10.20344/amp.13976. Epub 2020 Jul 23.
[Article in Portuguese]

Abstract

Introduction: The COVID-19 pandemic is a particularly relevant threat to mentally ill patients, and it constitutes a new challenge for health care providers. To the best of our knowledge, there is not any embracing published review about the use of psychotropic drugs during the COVID-19 pandemic.

Materials and methods: Non-systematic literature review. A search in the PubMed database was performed, with the terms 'psychotropic drugs', 'COVID-19', 'psychiatry' and 'pandemic'. Consensus and clinical guidelines about psychotropic drugs and COVID-19 approach, published by scientific societies, governmental entities and drug regulatory agencies were included.

Results and discussion: We present the recommendations about the use of psychotropic drugs during the COVID-19 pandemic, in the outpatient and inpatient settings. The treatment of affective bipolar disorder and schizophrenia have now added increased difficulties. Some psychotropic drugs interfere with the pathophysiology of the novel coronavirus infection and they could interact with the drugs used in the treatment of COVID-19. Some patients will need pharmacological interventions due to the presence of delirium. Smoking cessation changes the serum levels of some psychotropic drugs and may influence their use.

Conclusion: The COVID-19 pandemic has created new challenges in clinical practice. Psychiatric patients are a vulnerable population and often a careful clinical, laboratorial and electrocardiographic evaluation may be needed, particularly in those diagnosed with COVID-19. The regular treatment of mentally ill patients with COVID-19 presents increased complexity.

Introdução: A pandemia de COVID-19 constitui uma ameaça particularmente relevante para os portadores de doença mental e um novo desafio para os profissionais que os acompanham. Até à data, tanto quanto sabemos, não existe qualquer revisão abrangente publicada relativamente à utilização de fármacos psicotrópicos durante a pandemia COVID-19. Material e Métodos: Revisão não sistemática da literatura. A pesquisa na PubMed foi realizada com os termos ‘psychotropic drugs’, ‘COVID-19’, ‘psychiatry’ e ‘pandemic’. Foram incluídos os consensos e as normas publicadas pelas sociedades científicas, entidades governamentais e agências regulamentares de medicamentos. Resultados e Discussão: Apresentam-se recomendações relativamente à utilização de psicofármacos durante a pandemia COVID-19, em contexto de ambulatório e de internamento. O tratamento da perturbação afetiva bipolar e da esquizofrenia tem agora dificuldades acrescidas. Alguns psicofármacos interferem com os mecanismos fisiopatológicos envolvidos na infeção pelo novo coronavírus e têm interações com os fármacos utilizados no tratamento da COVID-19. Em doentes com COVID-19 e com delirium, a utilização de psicofármacos poderá ser necessária. A cessação tabágica altera os níveis séricos de alguns psicofármacos e pode condicionar a sua utilização. Conclusão: A pandemia de COVID-19 coloca novos desafios na prática clínica. Os doentes psiquiátricos constituem uma população vulnerável, sendo frequentemente necessária uma avaliação clínica, laboratorial e eletrocardiográfica cuidadosa, naqueles com o diagnóstico de COVID-19. Os doentes mentais com COVID-19 apresentam uma complexidade acrescida na gestão da sua terapêutica habitual.

Keywords: COVID-19; Pandemics; Psychiatry; Psychotropic Drugs.

Publication types

  • Practice Guideline
  • Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Benzodiazepines / therapeutic use
  • Betacoronavirus*
  • Bipolar Disorder / drug therapy
  • Body Temperature Regulation / drug effects
  • Body Temperature Regulation / physiology
  • Buprenorphine / adverse effects
  • Buprenorphine / therapeutic use
  • Clozapine / therapeutic use
  • Coronavirus Infections / complications
  • Coronavirus Infections / drug therapy
  • Coronavirus Infections / epidemiology*
  • Delayed-Action Preparations / therapeutic use
  • Drug Interactions
  • Hospitalization
  • Humans
  • Lithium Compounds / therapeutic use
  • Mental Disorders / complications
  • Mental Disorders / drug therapy*
  • Methadone / adverse effects
  • Methadone / therapeutic use
  • Narcotic Antagonists / adverse effects
  • Narcotic Antagonists / therapeutic use
  • Pandemics
  • Pneumonia, Viral / complications
  • Pneumonia, Viral / drug therapy
  • Pneumonia, Viral / epidemiology*
  • Psychotropic Drugs / therapeutic use*
  • Schizophrenia / drug therapy
  • Smoking Cessation Agents / therapeutic use
  • Valproic Acid / therapeutic use

Substances

  • Antiviral Agents
  • Delayed-Action Preparations
  • Lithium Compounds
  • Narcotic Antagonists
  • Psychotropic Drugs
  • Smoking Cessation Agents
  • Benzodiazepines
  • Buprenorphine
  • Valproic Acid
  • Clozapine
  • Methadone

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2