Expert Reaction: Fluvoxamine Shows Promise for Long COVID Fatigue

A study published in the Annals of Internal Medicine on March 30, 2026, investigated the effects of fluvoxamine (an antidepressant) and metformin on fatigue in patients diagnosed with Long COVID.

Prof. Christiaan Vinkers, a Psychiatrist and Stress & Resilience chair at Amsterdam University Medical Centre, provided an expert reaction to these findings.

Encouraging Evidence for Fluvoxamine

Vinkers noted that the randomized placebo-controlled trial offered encouraging evidence.

The study suggested that fluvoxamine may reduce fatigue in a specific group of Long COVID patients.

He described the research as methodologically solid, highlighting a low dropout rate and consistent signals regarding fatigue and quality of life improvements.

Critical Considerations and Limitations

However, Vinkers cautioned that the findings require careful interpretation.

He pointed out that the primary outcome was self-reported, and the study population excluded important groups, such as patients with depressive or anxiety disorders.

Furthermore, the research primarily focused on fatigue. It did not assess other common Long COVID symptoms like post-exertional malaise (PEM), autonomic symptoms (including POTS), or cognitive impairment. The study also did not include biomarker measures to help understand the underlying mechanisms.

Promising Results, But Replication is Key

Despite these limitations, Vinkers concluded that the results are promising. He emphasized the necessity of replication, ideally in broader patient groups and with outcomes that encompass the full spectrum of Long COVID.