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Mood Stabilizers Linked to Increased COVID-19 Risk in Serious Mental Illness

Patients with serious mental illnesses, especially schizophrenia, are at higher risk of bad outcomes with COVID-19. Find out how a new study determined that what medications they use could be having some effect. Mood stabilizers were associated with an increased risk of infection, while other drugs appeared to have the opposite effect.

ORANGEBURG, NY -- Psychotropic medication appears to influence the risk of COVID-19 infection among adults with serious mental illness but the effects vary.

That’s according to a new cohort study of 1,958 inpatients with serious mental illness in a statewide psychiatric hospital system. The article in JAMA Network Open reports that the use of second-generation antipsychotic medications, especially paliperidone, was linked to a decreased risk of COVID-19 infection.

On the other hand, according to Nathan S. Kline Institute for Psychiatric Research-led investigators, valproic acid use was associated with an increased risk of infection.

Background information in the report notes that, in general, patients with serious mental illness are at increased risk of severe COVID-19 infection. How that is affected by psychotropic medications was not previously understood, however.

The study team sought to evaluate the associations between the use of psychotropic medications and the risk of COVID-19 infection among adults with serious mental illness receiving long-term inpatient psychiatric treatment.

The study in New York was conducted between March 8 and July 1, 2020, with Dec. 1, 2020, being the final date of follow-up. Participants were the nearly 2,000 consecutive adult inpatients with serious mental illness (affective or nonaffective psychoses) who received testing for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction or antinucleocapsid antibodies and were continuously hospitalized from March 8 until medical discharge or July 1, 2020.

Most of the patients, 73.6%, were men, and the mean age was 51.4. COVID-19 infection was laboratory-confirmed in 969 patients (49.5%) that occurred while they were hospitalized. Death was the outcome in 38 cases, 3.9%.

“The use of second-generation antipsychotic medications, as a class, was associated with decreased odds of infection (odds ratio [OR], 0.62; 95% CI, 0.45-0.86), whereas the use of mood stabilizers was associated with increased odds of infection (OR, 1.23; 95% CI, 1.03-1.47),” researchers point out. “In a multivariable model of individual medications, the use of paliperidone was associated with decreased odds of infection (OR, 0.59; 95% CI, 0.41-0.84), and the use of valproic acid was associated with increased odds of infection (OR, 1.39; 95% CI, 1.10-1.76). Clozapine use was associated with reduced odds of mortality in unadjusted analyses (unadjusted OR, 0.25; 95% CI, 0.10-0.62; fully adjusted OR, 0.43; 95% CI, 0.17-1.12).”

The authors advise that serious mental illness patients are especially vulnerable to COVID-19, at least partly because they are more likely to have medical comorbidities associated with worse outcomes but still have a higher mortality rate from COVID-19 independent of these medical risk factors. The greatest increase in mortality risk is seen in schizophrenia patients, they add.