SSRI/SNRI and long COVID in children and adolescents with neuropsychiatric conditions: a cohort study from the RECOVER Initiative
Long COVID has been an important health concern in children and adolescents, yet factors associated with its development remain incompletely understood. Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are widely prescribed for pediatric neuropsychiatric conditions and may influence immune and autonomic pathways involved in postinfectious symptoms. Here we show associations between SSRI/SNRI use and long coronavirus disease (COVID)-related outcomes in a retrospective cohort of 110,955 children and adolescents with pre-existing neuropsychiatric conditions across 37 US health systems participating in the National Institutes of Health Researching COVID to Enhance Recovery consortium. SSRI/SNRI use was not associated with clinician-recorded long COVID diagnosis but showed heterogeneous associations with individual symptoms. Lower risks were observed for some symptoms, including fever, chills and hair loss, whereas higher risks were observed for neurological and systemic outcomes, including postural orthostatic tachycardia syndrome, cognitive dysfunction and fatigue. These findings suggest that antidepressant exposure may be associated with differing post-COVID symptom patterns in youth and warrant further investigation. Long COVID poses major health challenges in children and adolescents, and its development factors are still not fully understood. Here the authors analyze data from 110,955 young individuals with neuropsychiatric conditions, revealing that SSRI/SNRI use correlates with varied long COVID symptom risks, highlighting the need for further exploration of the impacts of antidepressants on post-coronavirus disease outcomes.
Authors
- Srinivasan Suresh (ORCID: https://orcid.org/0000-0003-1717-7593)
- Nita Jain (ORCID: https://orcid.org/0000-0002-4197-937X)
- Wenke Hwang (ORCID: https://orcid.org/0000-0002-8116-807X)
- Daniel Fort (ORCID: https://orcid.org/0000-0002-3759-4063)
- Abu Saleh Mohammad Mosa (ORCID: https://orcid.org/0000-0002-8956-1466)
- John E. Leikauf (ORCID: https://orcid.org/0000-0001-7364-1106)
- Rainu Kaushal (ORCID: https://orcid.org/0000-0002-4694-2517)
- Williams Dr
- Mady Hornig (ORCID: https://orcid.org/0000-0001-7572-3092)
- Aparna Swaminathan (ORCID: https://orcid.org/0000-0002-0003-9971)
- Rebecca Letts (ORCID: https://orcid.org/0009-0009-4747-7918)
- Sean N. Avedissian (ORCID: https://orcid.org/0000-0002-0935-6455)
- Yuriy Bisyuk (ORCID: https://orcid.org/0000-0003-2380-4776)
- Sharon J. Herring (ORCID: https://orcid.org/0000-0002-6136-521X)
- Josephine Elia (ORCID: https://orcid.org/0000-0002-5037-1622)
- Chengxi Zang (ORCID: https://orcid.org/0000-0002-8244-9551)
- Wyatt P. Bensken (ORCID: https://orcid.org/0000-0002-2597-9732)
- David C. Kaelber (ORCID: https://orcid.org/0000-0001-7855-9515)
- Michael J. Becich (ORCID: https://orcid.org/0000-0001-5998-8074)
- J S Chen
- Rachel Kenney
- Yong Chen (ORCID: https://orcid.org/0000-0003-0835-0788)
- Fei Wang (ORCID: https://orcid.org/0000-0001-9459-9461)
- Jonathan Arnold (ORCID: https://orcid.org/0000-0003-1185-555X)
- Ting Zhou (ORCID: https://orcid.org/0000-0003-3392-2979)
- Raghuram Prasad
- W Schuyler Jones
- N Pajor
- Heidi T. May
- Kelly Kelleher
- L. Charles Bailey
- Mollie R. Cummins
- Aaron Thomas Martinez
- Amy L. Salisbury
- Sandy Gonzalez
- Lindsay G. Cowell
- Yiwen Lu
- H. Timothy Bunnell
- Bingyu Zhang
- Mei Liu
- Leah Castro
- Dimitri A. Christakis
- Soledad Fernandez
- Haoyang Li
- Bradley W. Taylor
- Margot Gage Witvliet
- Elizabeth A. Chrischilles
- Neena Anne Thomas
- Christopher B. Forrest
- Suchitra Rao
Institutions
- University of Iowa (US)
- Cincinnati Children's Hospital Medical Center (US)
- Seattle Children's Hospital (US)
- Nebraska Medical Center (US)
- Nationwide Children's Hospital (US)
- Alfred I. duPont Hospital for Children (US)
- Feinstein Institute for Medical Research (US)
- Children's Hospital of Philadelphia (US)
- Ochsner Health System (US)
- University of Pittsburgh (US)
- Duke University (US)
- Virginia Commonwealth University (US)
- American Academy of Child and Adolescent Psychiatry (US)
- University of New Orleans (US)
- Medical College of Wisconsin (US)
- Cornell University (US)
- University of Utah (US)
- University of Michigan (US)
- University of Florida Health (US)
- Community Health Systems - Dupont Hospital (US)
- University Medical Center New Orleans (US)
- Intermountain Medical Center (US)
- University of Alabama at Birmingham (US)
- Clinical Research Institute (US)
- Children's Hospital Colorado (US)
- Southwestern Medical Center (US)
- Community Care (US)
- Nemours Children's Health System (US)
- Children's Hospital of Pittsburgh (US)
- Applied Mathematics (United States) (US)
- Ochin (US)
- Duke University Health System (US)
- Miami Children's Hospital (US)
- Department of Public Health (MM)
- MetroHealth Medical Center (US)
- Weill Cornell Medicine (US)
- The Ohio State University (US)
- New York University (US)
- University of Nebraska Medical Center (US)
- University of Cincinnati (US)
- University of Pennsylvania (US)
- Penn State Milton S. Hershey Medical Center (US)
- Temple University (US)
- The University of Texas Southwestern Medical Center (US)
- University of Colorado Denver (US)
- Center for Autism and Related Disorders (US)
Publication Details
- Journal
- Nature Mental Health
- Published
- 2026-06-29
- DOI
- https://doi.org/10.1038/s44220-026-00675-9
- Primary Topic
- Long-Term Effects of COVID-19
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health