CC BY-NC-ND 4.0 · Psychiatr Prax 2021; 48(08): 399-403
DOI: 10.1055/a-1531-4460
Übersicht

COVID-19-Impfung unter Psychopharmakotherapie

Vaccination Against COVID-19 in Patients Treated with Psychotropic Drugs
Johanna Seifert*
1   Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
,
Johannes Heck*
2   Institut für Klinische Pharmakologie, Medizinische Hochschule Hannover, Hannover
,
Gabriel Eckermann
3   Klinik für Forensische Psychiatrie und Psychotherapie, Bezirkskrankenhaus Kaufbeuren, Kaufbeuren
,
Monika Singer
4   kbo-Lech-Mangfall-Klinik Agatharied, Fachklinik für Psychiatrie, Psychotherapie und Psychosomatik, Hausham
,
Stefan Bleich
1   Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
,
Renate Grohmann
5   Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München
,
Sermin Toto
1   Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover
› Author Affiliations

Zusammenfassung

Seit Dezember 2020 stehen in der Europäischen Union Impfstoffe gegen SARS-CoV-2 zur Verfügung. Psychisch erkrankte Personen haben ein erhöhtes Risiko für einen schweren oder tödlichen Verlauf einer SARS-CoV-2-Infektion. So stellt sich die Frage, inwiefern Interaktionen zwischen den neuen SARS-CoV-2-Impfstoffen und Psychopharmaka zu erwarten sind. Grundsätzlich fehlen bislang noch konkrete Daten über die Verträglichkeit und Wirksamkeit einer Impfung gegen SARS-CoV-2 unter Psychopharmakotherapie – aus Untersuchungen zu Impfstoffen gegen andere Krankheitserreger lassen sich jedoch potenzielle Interaktionen ableiten, wie zum Beispiel eine reduzierte Immunantwort mit geringerer klinischer Wirksamkeit oder eine Erhöhung von Medikamentenspiegeln aufgrund einer indirekten Hemmung von metabolisierenden Enzymen durch Impfstoffe. Andererseits zeigen depressive Patienten, die mit Antidepressiva medikamentös behandelt werden, eine bessere Immunantwort.

Abstract

Vaccines against SARS-CoV-2 have been available in the European Union since December 2020. Persons suffering from mental illness have an increased risk of a severe or fatal course following an infection with SARS-CoV-2. Thus, the question arises to what extent interactions between the newly approved vaccines and psychotropic drugs may be expected. Data on the tolerability and efficacy of vaccines against SARS-CoV-2 under treatment with psychotropic drugs are not available to date – however, potential interactions can be derived from previous investigations on vaccines against other pathogens, such as a reduced immune response with lower clinical efficacy and an increase in drug plasma levels due to the indirect vaccine-mediated inhibition of metabolizing enzymes. On the other hand, depressed patients treated with antidepressant medication show a better immune response.

* geteilte Erstautorenschaft




Publication History

Article published online:
03 August 2021

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  • Literatur

  • 1 Polack FP, Thomas SJ, Kitchin N. et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020; 383: 2603-2615
  • 2 Baden LR, El Sahly HM, Essink B. et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. New Engl J Med 2020; 384: 403-416
  • 3 Voysey M, Clemens SAC, Madhi SA. et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet 2021; 397: 99-111
  • 4 Sadoff J, Le Gars M, Shukarev G. et al. Interim Results of a Phase 1–2a Trial of Ad26.COV2.S Covid-19 Vaccine. N Engl J Med 2021; 384: 1824-1835
  • 5 Taquet M, Luciano S, Geddes JR. et al. Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry 2021; 8: 130-140
  • 6 Li L, Li F, Fortunati F. et al. Association of a Prior Psychiatric Diagnosis With Mortality Among Hospitalized Patients With Coronavirus Disease 2019 (COVID-19) Infection. JAMA network open 2020; 3: e2023282-e2023282
  • 7 Nemani K, Li C, Olfson M. et al. Association of Psychiatric Disorders With Mortality Among Patients With COVID-19. JAMA Psychiatry 2021;
  • 8 Mazereel V, Van Assche K, Detraux J. et al. COVID-19 vaccination for people with severe mental illness: why, what, and how?. Lancet Psychiatry 2021;
  • 9 Seifert J, Heck J, Eckermann G. et al. [Psychopharmacotherapy during the COVID-19 pandemic]. Nervenarzt 2020; 91: 604-610
  • 10 Firth J, Siddiqi N, Koyanagi A. et al. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6: 675-712
  • 11 Hsu JH, Chien IC, Lin CH. et al. Increased risk of chronic obstructive pulmonary disease in patients with schizophrenia: a population-based study. Psychosomatics 2013; 54: 345-351
  • 12 Schneider M, Pauwels P, Toto S. et al. Severe weight gain as an adverse drug reaction of psychotropics: Data from the AMSP project between 2001 and 2016. Eur Neuropsychopharmacol 2020; 36: 60-71
  • 13 Ciabattini A, Garagnani P, Santoro F. et al. Shelter from the cytokine storm: pitfalls and prospects in the development of SARS-CoV-2 vaccines for an elderly population. Semin Immunopathol 2020; 42: 619-634
  • 14 Miller AH. Depression and immunity: a role for T cells?. Brain Behav Immun 2010; 24: 1-8
  • 15 Müller N. Inflammation in Schizophrenia: Pathogenetic Aspects and Therapeutic Considerations. Schizophr Bull 2018; 44: 973-982
  • 16 Prather AA, Janicki-Deverts D, Hall MH. et al. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep 2015; 38: 1353-1359
  • 17 Leschak CJ, Eisenberger NI. Two Distinct Immune Pathways Linking Social Relationships With Health: Inflammatory and Antiviral Processes. Psychosom Med 2019; 81: 711-719
  • 18 Hert MDE, Correll CU, Bobes J. et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 2011; 10: 52-77
  • 19 Muruganandam P, Neelamegam S, Menon V. et al. COVID-19 and Severe Mental Illness: Impact on patients and its relation with their awareness about COVID-19. Psychiatry Res 2020; 291: 113265
  • 20 Govind R, Fonseca de Freitas D, Pritchard M. et al. Clozapine treatment and risk of COVID-19 infection: retrospective cohort study. Br J Psychiatry 2020; 1-7
  • 21 Knol W, van Marum RJ, Jansen PA. et al. Antipsychotic drug use and risk of pneumonia in elderly people. J Am Geriatr Soc 2008; 56: 661-666
  • 22 Kuo CJ, Yang SY, Liao YT. et al. Second-generation antipsychotic medications and risk of pneumonia in schizophrenia. Schizophr Bull 2013; 39: 648-657
  • 23 Olfson M, Gerhard T, Huang C. et al. Premature Mortality Among Adults With Schizophrenia in the United States. JAMA Psychiatry 2015; 72: 1172-1181
  • 24 de Leon J, Ruan C-J, Verdoux H. et al. Clozapine is strongly associated with the risk of pneumonia and inflammation. General psychiatry 2020; 33: e100183-e100183
  • 25 Ponsford M, Castle D, Tahir T. et al. Clozapine is associated with secondary antibody deficiency. Br J Psychiatry 2018; 214: 1-7
  • 26 Aygun H. Vitamin D can prevent COVID-19 infection-induced multiple organ damage. Naunyn Schmiedebergs Arch Pharmacol 2020; 393: 1157-1160
  • 27 May M, Slitzky M, Rostama B. et al. Antipsychotic-induced immune dysfunction: A consideration for COVID-19 risk. Brain Behav Immun Health 2020; 6: 100097-100097
  • 28 Abe S, Suzuki T, Hori T. et al. Hypogammaglobulinemia during antipsychotic therapy. Psychiatry Clin Neurosci 1998; 52: 115-117
  • 29 Song C, Lin AH, Kenis G. et al. Immunosuppressive effects of clozapine and haloperidol: enhanced production of the interleukin-1 receptor antagonist. Schizophr Res 2000; 42: 157-164
  • 30 Więdłocha M, Marcinowicz P, Krupa R. et al. Effect of antidepressant treatment on peripheral inflammation markers – A meta-analysis. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80: 217-226
  • 31 Irwin MR, Levin MJ, Laudenslager ML. et al. Varicella Zoster Virus-Specific Immune Responses to a Herpes Zoster Vaccine in Elderly Recipients With Major Depression and the Impact of Antidepressant Medications. Clin Infect Dis 2013; 56: 1085-1093
  • 32 Ishizaka S, Yoshikawa M, Kitagami K. et al. Oral adjuvants for viral vaccines in humans. Vaccine 1990; 8: 337-341
  • 33 Young W. Review of lithium effects on brain and blood. Cell Transplant 2009; 18: 951-975
  • 34 Soria-Castro R, Schcolnik-Cabrera A, Rodríguez-López G. et al. Exploring the Drug Repurposing Versatility of Valproic Acid as a Multifunctional Regulator of Innate and Adaptive Immune Cells. J Immunol Res 2019; 2019: 9678098
  • 35 Himmerich H, Bartsch S, Hamer H. et al. Impact of mood stabilizers and antiepileptic drugs on cytokine production in-vitro. J Psychiatr Res 2013; 47: 1751-1759
  • 36 Godhwani N, Bahna SL. Antiepilepsy drugs and the immune system. Ann Allergy Asthma Immunol 2016; 117: 634-640
  • 37 Bernstein ED, Gardner EM, Abrutyn E. et al. Cytokine production after influenza vaccination in a healthy elderly population. Vaccine 1998; 16: 1722-1731
  • 38 Donato MT, Guillén MI, Jover R. et al. Nitric oxide-mediated inhibition of cytochrome P450 by interferon-gamma in human hepatocytes. J Pharmacol Exp Ther 1997; 281: 484-490
  • 39 Moschny N, Hefner G, Grohmann R. et al. Therapeutic Drug Monitoring of Second- and Third-Generation Antipsychotic Drugs – Influence of Smoking Behavior and Inflammation on Pharmacokinetics. Pharmaceuticals 2021; 14: 514
  • 40 Thompson D, Delorme CM, White RF. et al. Elevated clozapine levels and toxic effects after SARS-CoV-2 vaccination. J Psychiatry Neurosci 2021; 46: E210-E211
  • 41 Robertson Jr WC. Carbamazepine toxicity after influenza vaccination. Pediatr Neurol 2002; 26: 61-63
  • 42 Pellegrino P, Clementi E, Capuano A. et al. Can vaccines interact with drug metabolism?. Pharmacol Res 2015; 92: 13-17
  • 43 Kow CS, Hasan SS. Potential interactions between COVID-19 vaccines and antiepileptic drugs. Seizure 2021; 86: 80-81
  • 44 Jann MW, Fidone GS. Effect of influenza vaccine on serum anticonvulsant concentrations. Clin Pharm 1986; 5: 817-820
  • 45 Carnovale C, Raschi E, Leonardi L. et al. No signal of interactions between influenza vaccines and drugs used for chronic diseases: a case-by-case analysis of the vaccine adverse event reporting system and vigibase. Expert Rev Vaccines 2018; 17: 363-381
  • 46 Krämer I, Rauber-Lüthy C, Kupferschmidt H. et al. Minimal dose for severe poisoning and influencing factors in acute human clozapine intoxication: a 13-year retrospective study. Clin Neuropharmacol 2010; 33: 230-234