Clomipramine Could Be Useful in Preventing Neurological Complications of SARS-CoV-2 Infection
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LETTER TO THE EDITOR
Clomipramine Could Be Useful in Preventing Neurological Complications of SARS-CoV-2 Infection B. Nobile 1,2
&
M. Durand 3 & E. Olié 1,2,4 & S. Guillaume 1,2,4 & J. P. Molès 3 & E. Haffen 4,5 & P. Courtet 1,2,4
Received: 2 June 2020 / Accepted: 23 June 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Dear Dr. Gendelman, The global pandemic of the new coronavirus disease 2019 (COVID-19) has affected more than 7 million of people and provoked more than 400,000 deaths worldwide. In view of the urgent need of efficient treatments and the time to develop specific antiviral drugs, drug repositioning seems to be a good compromise (Sanders et al. 2020). Among the different aspects of COVID-19 physiopathology, the excessive inflammation following infection rapidly emerged as an important issue. Indeed, the significant damages in lungs and other organs observed are mainly explained by amplified immune response and cytokine release (Sanders et al. 2020). Tocilizumab (a humanized anti-IL-6 monoclonal antibody) has shown promising effects in reducing COVID-19 severity and mortality (Sanders et al. 2020). This suggests that targeting the “cytokine storm” seems to be efficient. On the other hand, SARS-CoV-2 was found in the cerebrospinal fluid of infected patients; additionally partial neuronal degeneration was observed in deceased patients (Wu et al. 2020). This tropism for the central nervous system (CNS) is also reflected by some COVID-19 symptoms, such as anosmia, dysgeusia, agitation, confusion, epilepsy, ischemic
* B. Nobile [email protected] 1
Department of Emergency Psychiatry and Acute Care, CHU Montpellier, Montpellier, France
2
PSNREC, INSERM, CHU de Montpellier, University Montpellier, Montpellier, France
3
Pathogenesis and control of chronic infection, INSERM, EFS; CHU Montpellier, Montpellier, University of Montpellier, Montpellier, France
4
FondaMental Foundation, Créteil, France
5
Service de Psychiatrie de l’Adulte, CIC-1431 INSERM, CHU de Besançon, Laboratoire de Neurosciences, Université de Franche-Comté, UBFC, Besançon, France
attacks, cognitive impairment (sometimes severe), and also encephalitis, leading to brain inflammation and lesions (Wu et al. 2020). In addition, brain damage caused by viral infection could lead to psychiatric consequences. Indeed, other coronaviruses have already been associated with the emergence of psychiatric disorders (e.g. psychosis, major depression) (Severance et al. 2011). This could be the consequence of the high inflammation induced by the infection. Effectively, an increase in cytokine levels reduces serotonin bioavailability, inhibits dopamine synthesis, increases glutamate release from astrocytes, alters the negative feedback of the hypothalamic–pituitary–adrenal axis and also impact neuroplasticity (Bauer and Teixeira 2019). Deregulation of these systems and inflammation have been associated with psychiatric disorders such as depression, bipolar disorder, schizophrenia and suicidal behavior (Bauer et Tei
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