> Our animal models demonstrate that serotonin levels can be restored and memory impairment reversed by precursor supplementation or SSRI treatment. While the effectiveness of SSRIs in acute COVID-19 has been a subject of debate,69,70,71,72,73,74 no systematic exploration of SSRIs in individuals with PASC has been performed to date. Our study, together with recent findings linking depression with cognitive impairment in Long COVID75 and the effect of SSRIs on vagus nerve activity,67 call for the assessment of targeting serotonin signaling for the prevention or treatment of neurocognitive manifestations.
I’d been suffering from some “depression lite” symptoms, mostly generalized anxiety since 2020, maybe long covid, who knows, and a reasonably small prescription of Xoloft has had a huge change in my mood/life.
That's interesting - did the psychiatrist explained it like that ? I feel the same way for so many months, but also wouldn't call depressed. Just always anxious, never rested, always in a mood... I attribute to work and other stresses though.
My gut reaction (pun intended) or guess on what causes Long Covid is a viral reservoir, possibly in the gut, that the immune system cannot fully clear. Low serotonin is then a downstream effect from the chronic stress on the body. Approx. 90% of serotonin found in the human body is located in the (GI) tract. So people and doctors will throw SSRIs at the problem, and maybe that will relieve some symptoms, but will not address the fundamental cause. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10171832/
In that case, a gastrointestinal lavage (as applied before a colonoscopy) could be a potential remedy. It's a long shot, but since the process doesn't have any side effects (other than the inconvenience of having to change your diet for a few days), it'd be worth a try.
> So people and doctors will throw SSRIs at the problem, and maybe that will relieve some symptoms, but will not address the fundamental cause.
Additionally, SSRIs cause severe - and in many cases permanent - side effects. What's worse, we don't even really know how SSRIs work - or if at all (at least, as intended). Nevertheless, they're handed out like sweets.
While most of the body’s serotonin is indeed in the gut, the serotonin that impacts our mood, sleep, and other cognitive functions is exclusively produced and used in the brain.
Was going to say this. My one gripe with HN is that people say incorrect things with complete confidence pretty regularly and you can only
Detect it if you know the subject matter.
While the serotonin used in your gut doesn’t directly impact the brain, it does impact the enteric nervous system which communicates via the vagus nerve to your brain. So I don’t think it’s correct to say this doesn’t (or couldn’t) impact your mood (and indeed murine experiments demonstrate it does).
The evidence supporting any specific, direct behavioral function of serotonin in the brain is only marginally more substantial than the evidence supporting any specific, direct behavioral function of serotonin in the gut[1]. If anything, the evidence suggests that the behavioral effects of serotonin are more global and abstract, mediated via downstream effects on other neurotransmitters and circuits controlled chiefly by other neurotransmitters, such that behavioral correlations can only be drawn generally and indirectly.
Your confidence is totally and completely unwarranted.
We still need to understand the gut <-> brain connection and why trials like prozac or precursor supplementation helps.
It is already inconclusive that SSRIs help acute covid, but no studies have been done for long covid. That's what the researchers are calling out here.
It also seems likely that at least some of the cases of depressive symptoms and lack of fitness is due to covid isolation, which entailed a precipitous decline in both physical and social activity for a lot of people.
That was exactly my take on this study, and I wasn't happy about seeing the jump to "WE NEED MORE SSRIS, LOOK IT'S SEROTONIN" - it's already been proven that serotinin disruptions in depression are a symptom so this is the same but doctors/pharma continue to cling to the outdated "low serotonin"
The other side effect this may have is delegitimatizing the condition, much like SSRIs are thrown at chronic pain, menstrual issues and more. Since the medical institution doesn't really take these conditions seriously this is going to become another half recognized condition that doctors can say "Maybe it's Long Covid HAVE YOU TRIED SSRIS" vs working with the patient or doing research into the true causes.
The main "long covid" symptom I really detest is the loss of smell/taste - after almost 2 years I still cannot smell or taste certain things, the worst being cinnamon in things like cinnamon grahams and cinnamon buns, strangely though I can taste the cinnamon fire jolly ranchers ok.
I sound like I'm jesting, but I love food, and I'm a big fan of scent too - things just don't smell or taste right anymore.
SSRIs can cause neurogenesis, wonder if that's some of the interaction - I thought perhaps the exhaustion could be too much tryptophan turning into serotonin in the brain, which causes fatigue?
Yeah my interest in trying new foods and enjoyment in eating food itself has decreased at lot after getting covid. Had loss of taste during covid and it recovered a lot over a few months but never really came back to what it was before.
Though I guess it's not really a long covid symptom since it's not anything active, just a result of getting covid.
For those now curious about taking an SSRI, please carefully research the sometimes permanent issues that can arise. It is not a class of medication to play around with.
Things like:
- Sexual dysfunction. Unable to maintain physical arousal or reach orgasm. Mental arousal may be hyper or hypo active. You take having a working dick for granted until it stops working.
- Tinnitus
- Depression/suicidal ideation. It should be noted that “suicidal ideation” less typically expresses as a direct “Yeah alright, time to kill myself now” sort of thoughts, which is often called “active ideation”. Instead it’s more often “passive ideation”, something like “I now spend hours in an whirlpool of involuntary negativity, a sort of emotional agony at existing. Daydreaming about dying/disappearing/evaporating is my only source of comfort, and hope for escape”.
- It can fuck with the very important but often ignored mechanisms that determine if your body is satisfied with what and how much you’ve eaten. Imagine the feeling of never quite having eaten enough, or always having eaten too much.
There are other things but those are the big ones I recall offhand. The side effects listed on medications are always horribly understated, because they come without human context.
We don’t actually know how SSRIs (or really, any neurochemical effecting med) work, and have no way of predicting the efficacy or side effects for a given individual yet, outside of trial and error.
Can concur. SSRIs are nasty, and waaaay overprescribed IMO. I'm so glad I got off Lexapro, but I haven't been quite the same since before I started it.
I'm surprised there is no randomized controlled trial of the effect of Vitamin D on Long Covid.
When I browse through Pubmed and read studies (a/b-tests) of Vitamin D intake and respiratory tract infections (including Covid), many large studies found a positive effect.
Good to see that there are some studies under way now.
How do you mean "preventative in nature"? Are you aware of any studies which a/b tested Vitamin D on active respiratory tract infections which showed that the Vitamin D has no effect in this situation?
You shouldn’t be surprised at this at all. There is zero profit motive for the amount of money it would take to do a vitamin D trial since no one can patent vitamin D.
I always feel like the people who make these sort of comments have never actually read a medical journal.
A huge amount of study does not lead to patentable medication, but is either performed by research groups, or is performed as part of R&D of another products and then published in papers.
Elder friend of mine got the fatigue two weeks after covid. after everything else was ruled out she was given ssris for anxiety, and indeed she could walk again a few weeks later.
If this turns out to be as interesting as it sounds, well buy SSRI maker stocks
Not to deny your friends experience, but just to shed light on an issue common with chronic illnesses:
People naturally heal all the time from illnesses like this. They just get better with time.
People also get desperate (and sometimes their doctors) and try all manner of remedy.
You get a situation where people who naturally recover end up attributing that recovery to whatever random remedy they were trying at the time. This can be compounded by having bands of people who got sick around the same time, tried whatever flavor of the month remedy was talked about at the time, and recovered around the same time.
Having long covid myself since summer 2020, I've watched this play out more times than I can count now.
This happens all the time with sports overuse injuries also. Kinesio tape, acupuncture, chiropractor adjustments, heat, ice. People try all kinds of things, eventually you get better. Whatever you tried last seems like it helped. But who knows.
I'd be very careful with SSRIs. This might very well turn out to be a case of the cure being worse than the disease.
> If this turns out to be as interesting as it sounds, well buy SSRI maker stocks
Unfortunately, that suggestion on the other hand might be spot-on. Not because SSRIs truly are the cure-all they're often marketed as, but rather because manufacturers have managed to sell them as such.
Totally don’t want to pick on you but this kind of thinking makes me really wish we could fork the universe right before giving the meds and compare the results of both universes. Ugh. Stupid physics.
dont do it just because. in our case we pretty much did every kind of medical exam possible, she did display multiple anxiety symptoms that seemed like panic attacks and the fatigue was clearly related to it.
Thanks for pointing me to that comment so I could upvote it. His comment is not accurate in that there are plenty of theories, but the general idea behind the claim is far more accurate than what probably many that frequent HN believe about long COVID. Long COVID is poorly understood and the research around it has overall been inconclusive, and much of it very low-quality:
Even the linked article has a bunch of caveats like:
Joanna Hellmuth, a cognitive neurologist and clinical researcher at UC, San Francisco, who has collaborated with some of the authors but was not involved in the current study, questions the paper’s focus on the hippocampus. She notes there’s currently little evidence the typical cognitive symptoms of Long Covid are linked to memory encoding in this brain region. Although the results are interesting, in her view, “the model they’re testing doesn’t reflect the clinical condition.”
> Long COVID is poorly understood and the research around it has overall been inconclusive
This is far from the truth. Over 400 long covid publications a month for the last couple years. Science has pushed this forward to be more conclusive and defined.
Covid contrarians like Vinay are nothing but minimizers with MDs. They cherry pick what serves their narrative while ignoring the rest.
Also, do you think that, in July 2020, that "most people [were] dramatically overestimating COVID-19 risk"? (As the comment I linked to stated.)
On July 12 and 13th, 2020, my uncle emailed me, "For what it’s worth, I predict the COVID-19 death toll in the next 30 months will be 2.5-3 million Americans." I emailed him "I don't know what to predict.... By 2023, I'll go with 300,000."
I'm pretty certain that my 300,000 Americans by 2023 was dramatically higher than what most people were estimating. And I was low.
And at that point, July 2020, I was just barely beginning to be concerned about long-term health impacts of those who survive COVID.
Readit News
https://www.thelancet.com/journals/laninf/article/PIIS1473-3...
https://www.nature.com/articles/s41590-023-01601-2
https://www.nature.com/articles/s41586-023-06651-y
https://www.youtube.com/watch?v=z189Z7tS1w4
https://www.youtube.com/watch?v=VYNMzaZk_iU
The researchers here have a specific hypothesis:
> Our animal models demonstrate that serotonin levels can be restored and memory impairment reversed by precursor supplementation or SSRI treatment. While the effectiveness of SSRIs in acute COVID-19 has been a subject of debate,69,70,71,72,73,74 no systematic exploration of SSRIs in individuals with PASC has been performed to date. Our study, together with recent findings linking depression with cognitive impairment in Long COVID75 and the effect of SSRIs on vagus nerve activity,67 call for the assessment of targeting serotonin signaling for the prevention or treatment of neurocognitive manifestations.
https://www.cell.com/cell/fulltext/S0092-8674(23)01034-6
Dead Comment
Dead Comment
In that case, a gastrointestinal lavage (as applied before a colonoscopy) could be a potential remedy. It's a long shot, but since the process doesn't have any side effects (other than the inconvenience of having to change your diet for a few days), it'd be worth a try.
> So people and doctors will throw SSRIs at the problem, and maybe that will relieve some symptoms, but will not address the fundamental cause.
Additionally, SSRIs cause severe - and in many cases permanent - side effects. What's worse, we don't even really know how SSRIs work - or if at all (at least, as intended). Nevertheless, they're handed out like sweets.
Your confidence is totally and completely unwarranted.
[1] https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-c...
We still need to understand the gut <-> brain connection and why trials like prozac or precursor supplementation helps.
It is already inconclusive that SSRIs help acute covid, but no studies have been done for long covid. That's what the researchers are calling out here.
The other side effect this may have is delegitimatizing the condition, much like SSRIs are thrown at chronic pain, menstrual issues and more. Since the medical institution doesn't really take these conditions seriously this is going to become another half recognized condition that doctors can say "Maybe it's Long Covid HAVE YOU TRIED SSRIS" vs working with the patient or doing research into the true causes.
I sound like I'm jesting, but I love food, and I'm a big fan of scent too - things just don't smell or taste right anymore.
SSRIs can cause neurogenesis, wonder if that's some of the interaction - I thought perhaps the exhaustion could be too much tryptophan turning into serotonin in the brain, which causes fatigue?
Though I guess it's not really a long covid symptom since it's not anything active, just a result of getting covid.
- Sexual dysfunction. Unable to maintain physical arousal or reach orgasm. Mental arousal may be hyper or hypo active. You take having a working dick for granted until it stops working.
- Tinnitus
- Depression/suicidal ideation. It should be noted that “suicidal ideation” less typically expresses as a direct “Yeah alright, time to kill myself now” sort of thoughts, which is often called “active ideation”. Instead it’s more often “passive ideation”, something like “I now spend hours in an whirlpool of involuntary negativity, a sort of emotional agony at existing. Daydreaming about dying/disappearing/evaporating is my only source of comfort, and hope for escape”.
- It can fuck with the very important but often ignored mechanisms that determine if your body is satisfied with what and how much you’ve eaten. Imagine the feeling of never quite having eaten enough, or always having eaten too much.
There are other things but those are the big ones I recall offhand. The side effects listed on medications are always horribly understated, because they come without human context.
We don’t actually know how SSRIs (or really, any neurochemical effecting med) work, and have no way of predicting the efficacy or side effects for a given individual yet, outside of trial and error.
Tread extremely carefully.
When I browse through Pubmed and read studies (a/b-tests) of Vitamin D intake and respiratory tract infections (including Covid), many large studies found a positive effect.
https://clinicaltrials.gov/study/NCT05633472
https://clinicaltrials.gov/study/NCT05356936
https://clinicaltrials.gov/study/NCT05630339
https://clinicaltrials.gov/study/NCT04536298
How do you mean "preventative in nature"? Are you aware of any studies which a/b tested Vitamin D on active respiratory tract infections which showed that the Vitamin D has no effect in this situation?
A huge amount of study does not lead to patentable medication, but is either performed by research groups, or is performed as part of R&D of another products and then published in papers.
If this turns out to be as interesting as it sounds, well buy SSRI maker stocks
People naturally heal all the time from illnesses like this. They just get better with time.
People also get desperate (and sometimes their doctors) and try all manner of remedy.
You get a situation where people who naturally recover end up attributing that recovery to whatever random remedy they were trying at the time. This can be compounded by having bands of people who got sick around the same time, tried whatever flavor of the month remedy was talked about at the time, and recovered around the same time.
Having long covid myself since summer 2020, I've watched this play out more times than I can count now.
NAC + Aspirin is the only thing that helps me but it also makes me feel detached and not hyper as my previous brain state.
Really? SSRIs are outside of patent so there is little moat and thin margins.
> If this turns out to be as interesting as it sounds, well buy SSRI maker stocks
Unfortunately, that suggestion on the other hand might be spot-on. Not because SSRIs truly are the cure-all they're often marketed as, but rather because manufacturers have managed to sell them as such.
I don't take an SSRI but perhaps it could indeed help.
[1] https://news.ycombinator.com/item?id=23875391
https://vinayprasadmdmph.substack.com/p/long-covid-kills-sad...
https://www.youtube.com/watch?v=yqAjrMNN-Vs
https://www.youtube.com/watch?v=D4NqsU-Dk9A
https://www.dailywire.com/news/taxpayer-funded-1-billion-lon...
Even the linked article has a bunch of caveats like:
Joanna Hellmuth, a cognitive neurologist and clinical researcher at UC, San Francisco, who has collaborated with some of the authors but was not involved in the current study, questions the paper’s focus on the hippocampus. She notes there’s currently little evidence the typical cognitive symptoms of Long Covid are linked to memory encoding in this brain region. Although the results are interesting, in her view, “the model they’re testing doesn’t reflect the clinical condition.”
This is far from the truth. Over 400 long covid publications a month for the last couple years. Science has pushed this forward to be more conclusive and defined.
Covid contrarians like Vinay are nothing but minimizers with MDs. They cherry pick what serves their narrative while ignoring the rest.
On July 12 and 13th, 2020, my uncle emailed me, "For what it’s worth, I predict the COVID-19 death toll in the next 30 months will be 2.5-3 million Americans." I emailed him "I don't know what to predict.... By 2023, I'll go with 300,000."
I'm pretty certain that my 300,000 Americans by 2023 was dramatically higher than what most people were estimating. And I was low.
And at that point, July 2020, I was just barely beginning to be concerned about long-term health impacts of those who survive COVID.
a) We do not have evidence that humans suffer from long-term consequences of COVID-19.
b) We do not know why humans suffer long-term consequences of COVID-19.
c) We have no evidence that COVID-19 could possibly cause long-term consequences.
Because I think the answer you have... is different from the answer that [1] would have.
I think [1] thinks c). And I think you think b) or possibly a).
Or maybe I'm wrong - do you agree with c?
[1] https://news.ycombinator.com/item?id=23875391
I'll have to remember that one. Really succinct.
Proclaiming that there wasn't even a "theoretical basis"... It was just so... obviously wrong. And honestly, dangerous.