The role of peripheral serotonin in SARS ‐ CoV ‐2 infectivity, COVID ‐19 treatment and long COVID

Mar 8, 2026Immunology and cell biology

How Serotonin Outside the Brain May Affect COVID-19 Infection, Treatment, and Long-Term Symptoms

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Abstract

Gastrointestinal symptoms such as diarrhea and nausea are common in SARS-CoV-2 infection.

Gastrointestinal symptoms are frequently reported in COVID-19 cases and may contribute to overall morbidity.
The gastrointestinal tract may serve as a potential entry point for the virus, possibly affecting disease progression.
SARS-CoV-2 infection may influence gut-derived serotonin levels, which could be linked to associated symptoms.
There is a potential connection between serotonin levels and the effectiveness of selective serotonin reuptake inhibitors in managing COVID-19 severity.

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Gastrointestinal symptoms have emerged as a common, but underappreciated, cause of morbidity in relation to SARS-CoV-2 infection and the COVID-19 pandemic. This manifests as a range of indications including diarrhea, anorexia, nausea, vomiting and abdominal pain. In addition, the gastrointestinal tract may represent a route of viral entry via the epithelial cell layer lining the gut wall. This route of entry could be a significant component of disease pathogenesis, including effects on the nervous system via the gut-brain axis. In this review, we provide an assessment of the effects of COVID-19 on the gastrointestinal system, its involvement in disease severity and potential pathways for viral entry and infection in the gastrointestinal tract. We also examine evidence that gut-derived serotonin is affected by SARS-CoV-2 infection, how this may link to symptoms and disease pathogenesis and the potential link to the efficacy of selective serotonin reuptake inhibitors in reducing COVID-19 severity.

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The role of peripheral serotonin in SARS ‐ CoV ‐2 infectivity, COVID ‐19 treatment and long COVID

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