No reduced serum serotonin levels in patients with post-acute sequelae of COVID-19

Purpose: Approximately 10-20% of patients previously infected with SARS-CoV-2 experience post-acute sequelae of COVID-19 (PASC), presenting with fatigue and neurocognitive dysfunction along various other symptoms. Recent studies suggested a possible role of a virally induced decrease in peripheral serotonin concentration in the pathogenesis of PASC. We set out to verify this finding in an independent and well-defined cohort of PASC patients from our post-COVID-19 outpatient clinic.

Methods: We performed a retrospective case-control study including 34 confirmed PASC patients and 14 healthy controls. Clinical assessment encompassed physician examination as well as questionnaire based evaluation. Eligibility required ongoing symptoms for at least 6 months post-PCR-confirmed infection, relevant fatigue (CFS ≥ 4), and no other medical conditions. Serum serotonin was determined by LC-MS/MS technique.

Results: Serum serotonin levels in PASC patients did not significantly differ from healthy controls. Most subjects had normal serotonin levels, with no subnormal readings. Subgroup analyses showed no significant differences in serotonin levels based according to predominant fatigue type, high overall fatigue score or depression severity.

Conclusion: We postulate that peripheral serotonin is no reliable biomarker for PASC and that it should not be used in routine diagnostic. Therapy of PASC with serotonin-reuptake inhibitors or tryptophane supplementation should not be based solely on the assumption of lowered serotonin levels.