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Cheap antidepressant shows promise treating early Covid-19
- rajmann 5y agoDr. Farid Jalali has been talking about the Serotonin link to covid, and had been recommending antiserotonergic drug Cyproheptadine for its treatment. https://www.youtube.com/watch?v=Wetdq9vX__c https://www.youtube.com/watch?v=Wetdq9vX__c
- addicted 5y agoI’m curious if the Ivermectin crowd will latch onto this drug that actually appears to help with COVID. Probably not because the Ivermectin crowd is a whole lot of snake oil salesmen and they can’t profit from a drug that your doctor might suggest.
- SV_BubbleTime 5y agoSarcasm and hyperbole incoming but… Surely there could be no side effects of putting even more people on SSRIs! well how many more people you thinking? Covid-many.
- 404mm 5y agoI wonder how objective/subjective were the criteria for going to the hospital. I don’t meant to make fun of it but is there a chance that fewer patients either didn’t panic or simply didn’t care enough?
- shapefrog 5y agoAre psychiatric disorders risk factors for COVID-19 susceptibility and severity? a two-sample, bidirectional, univariable, and multivariable Mendelian Randomization study https://www.nature.com/articles/s41398-021-01325-7 https://www.nature.com/articles/s41398-021-01325-7 Some studies found links, some didnt, all depends on how you slice the data. I would imagine quite difficult to get a sense when the major risk factors (age and weight) are so dominant.
- deleted 5y ago[deleted]
- abecedarius 5y agoIANAD but I'd expect taking it during an infection to have different risks from taking it over a long period or permanently.
- pdkl95 5y agoI still would urge caution before taking any amount of SSRI[1]. They are very useful tools that work well for many people, but some people do get very serious side effects. They can also be difficult to stop, sometimes requiring very slow dose tapering over many months. In my personal experience from both a multi-year experience with fluoxetine and (~5 years later) a short (~4-weeks-ish? I think?) experience with tramadol, there were serious side effects that lasted many months after I stopped taking the drug. I think I was still getting regular 'brain zaps' for almost a year. Every medication requires weighing the expected benefits vs the adverser effects and risks. I'm not saying SSRIs/etc are bad. I just urge caution and respecting them like the powerful tools they are. Powerful tools - like SSRIs, opiates, or a table saw - are great if you need them, but you do need to understand them properly or you might loose a finger. (that said, any SSRI side effects is almost certainly a better option than dying from covid, but... seriously... get vaccinated and do what you can (masks, limiting crowds, etc) so you - and the people you interact with - hopefully don't get covid at all) [1] or anything that messes with serotonin like the SNRIs, SNDRIs, MDMA and related phenethylamines, or even stuff like the painkiller tramadol (it's also an SNRI)
- abecedarius 5y agoI'm sorry to hear of those troubles. Yes, I'd have said some of the same things minus the direct experience if I were to give my opinions -- just wanted to counter where the GP comment seemed unreasonable.
- blitzar 5y agoSarcasm and hyperbole incoming but… IF, big if, you are of the persuasion that the vaccine is a dna altering, 5g brain chip, population steralisation project; why would you want to see even more people being given SSRIs? SSRIs are incredible, opiates are also incredible, both true wonders of modern medcine, especially for those that need them and truly wonderful tools for doing what they do. But they can also be terrible, really terrible, particularly when handed out in pez dispensers.
- blinkingled 5y ago> In the group that took the drug, 11% needed hospitalization or an extended ER stay, compared to 16% of those on dummy pills. Is that really promising? Very close to margin of error if not within.
- pertymcpert 5y ago> The results, published Wednesday in the journal Lancet Global Health, were so strong that independent experts monitoring the study recommended stopping it early because the results were clear.
- nottorp 5y agoI'd like some info about those "independent experts".
- darkerside 5y agoThis sounds suspiciously vague. What experts? How did they become involved? Did they stop it because the study proved an effect, or because it was clearly not designed to be able to prove an effect?
- _3u10 5y agoHow does your ad hominem questioning of their expertise / how they became involved invalidate the results? The study reached its statistical significance goal, and thus the study was ended as it would be immoral beyond that point to continue to give people placebos when they knew the drug was working. I'd suggest reading up on the Tuskegee syphilis study for the ethics behind why studies are ended early once treatments have been statistically validated.
- batter 5y agoThis is not new. A lot of discussions on Twitter. This mostly helps with avoiding hospitals. But didn't yet see studies to reduce mortality.
- fareesh 5y agoI'll take my chances with the corona. Don't want SSRI
- woodruffw 5y agoSSRIs are pretty serious, which is why you should probably just get vaccinated instead.
- HamburgerEmoji 5y ago[dead]
- _huayra_ 5y agoIt's so strange how people are looking to truly foreign substances / drugs (from ivermectin to bleach to SSRIs now) compared to a vaccine, which is basically just a bunch of mRNA and a few preservatives. That is, a bunch of stuff that is basically already floating around in our bodies / cells.
- bsaul 5y agoi guess it's just natural distrust of anything that's new (mrna vaccines are most certainly a first time here). And tbh i find this suspicion quite reasonable.
- woodruffw 5y agoAs a bit of historical trivia: the historical development timeline for SSRIs runs roughly parallel with that with the development timeline for mRNA vaccines. They’re roughly the same age.
- toomanybeersies 5y agoWhy not both? Vaccination isn't a silver bullet.
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- rebuilder 5y agoI wonder what rate of adverse effects will be considered acceptable for a drug administered to people known to have the virus? For vaccines, our tolerance seems very low. I suspect we don’t actually think prevention is better than a cure.
- _3u10 5y agoIt would depend greatly on their age, I would posit for that those over 65, any drug that killed less than 10% of the people who took it would be acceptable. Vaccines are part of a broader political debate, the problem in politics is people are picking sides. It's very rare to run into a person who doesn't support the vaccine mandates but did get vaccinated. People are generally either anti-vax & anti-mandate, or vaccinated and pro-mandates. The antivax crowd uses the same persuasion techniques to discourage vaccination that media uses to convince young people that COVID poses any risk of mortality to those under 17. That is to say one or two extremely rare outcomes are trumpeted loudly in order to convince society at large of the danger that is virtually non-existent.
- jokethrowaway 5y agoI disagree. I got the vaccine hoping it would make travelling easier and because I don't want to spend money on useless tests. Too bad I ended up having to get tested anyway.
- nitrogen 5y agoIt's very rare to run into a person who doesn't support the vaccine mandates but did get vaccinated. Or it's very rare for them to say so in the presence of fear mobs. Mixed opinions are far more common than their (in)visibility would suggest.
- _3u10 5y agoGood point. This does seem to be the predominant view of my friends but I had assumed heavy sampling bias.
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- m0zg 5y agoI bet with crystal meth you won't even notice your COVID if you take enough of it. Not sure it's a worthwhile tradeoff though, though I'm sure "legalize everything" crowd would disagree. Taking SSRIs to very marginally reduce severity seems like an extremely dumb idea.
- weird-eye-issue 5y agoDid you just compare crystal meth with SSRIs?
- nottorp 5y agoThat's what my first thought was. Treating a viral infection with an anti depressant means to me that you just won't notice how sick you are.
- AzzieElbab 5y agoIn that case alcohol would do the job just as well
- nottorp 5y agoProbably. At least until the hangover.
- weird-eye-issue 5y agoNot sure what you guys are talking about. It's just going to make you feel worse. You want to be sick and drunk/high? Sounds miserable
- AzzieElbab 5y agoI grew up in the Soviet Russia. Vodka cures everything. Prove me wrong! Ok, I was making a joke in the original reply to begin with
- _ywdj 5y agoFrom my own experience I can very much believe an SSRI could have an effect on the immune system and/or the respiratory system. I was a heavy cigarette smoker in my 20s, and over those years, I experienced worsening asthma and also worsening anxiety and depression. Eventually I was prescribed an SSRI (Zoloft), and found that not only did my mood change, my asthma completely abated, even though I was still smoking just as much. After a few months I decided I didn't like all that the SSRI was doing to my psyche, so when the prescription finished I tapered off it, and sure enough the asthma returned a few months later. I've never enquired much as to what what was going on - I didn't speak to doctors or other people about it. But the correlation between SSRI intake and asthma abatement was very clear. (And yes I know it was very stupid to be smoking as an asthmatic - I quit completely the following year and have stayed off them for coming-on 15 years. I've also been mostly asthma-free in that time, though it returned for a few months about 7 years ago, after a period of intense career-related stress, but then cleared up after I undertook some healing work that included both immune-system support and emotional healing.)
- ttul 5y agoAren’t many SSRIs antihistaminergic?
- jinder 5y agoMany antidepressants are (e.g. Mirtazapine), but not Sertraline (Zoloft).
- johnisgood 5y agoAnd some old antihistamines were SSRIs.
- podgaj 5y agoNo SSRI's are antihistaminergic. It is right in the name. SSRI only inhibit serotonin reuptake. Many antipsychotics have histamine receptor inhibition, but there are no antidepressants that block the histamine receptors.
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- lettergram 5y agoGlad to see this being spoken about! I’ve been assisting with data analysis for an eclectic group of people (who funded this study). Been really disheartening to watch the politics around alternative treatments. Personally, I expect this to be attacked as well, but am hopeful! The stuff really does seem effective, particularly when combined with other drugs...
- onion2k 5y agoI hope this isn't attacked, because this isn't an "alternative" drug. Things move from "alternative medicine" to being "medicine" when people do good, peer-reviewed science to actually study the effects and find them to be effective. "Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used.
- chrisco255 5y agoYes, all you need to do is conduct a study and you will get an objective peer review from other researchers funded by pharmaceutical giants and news outlets funded by the same.
- twofornone 5y ago>"Alternative medicine" like ivermectine or hydroxychloroquine have no scientific, properly studied basis for being used. There are more than 60 peer reviewed studies showing positive effect for ivermectin. Similarly the single trial that the media touted as "proof" that HCQ did not work administered what amounted to an overdose to terminally ill patients, in contrast to the recommended early/prophylactic regimen. These lies have gone on for far too long - no thanks to irresponsible and, frankly, inexcusable censorship by fb, youtube et al on grounds of "misinformation". This site[0] has been up for over a year now and the citation count has continued to grow. It seems people are more interested in poo pooing proponents of ivermectin/HCQ than actually examining evidence. Medicine should not be a political team sport. 0. ivmmeta.com
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- rscho 5y agoThis thread has the strongest 'pseudoexpert-statistical-bro' vibe I ever experienced. It's amazing! You can have your own beliefs regarding COVID, but it surely revealed a lot about the social perception of statistics... #-/
- deepnotderp 5y agoAs opposed to "experts" who always have rock solid statistical knowledge (/s): https://stats.stackexchange.com/questions/38403/what-causes-the-discontinuity-in-the-distribution-of-published-p-values-at-p https://stats.stackexchange.com/questions/38403/what-causes-... https://en.wikipedia.org/wiki/Misuse_of_p-values https://en.wikipedia.org/wiki/Misuse_of_p-values I wish that people would stop disparaging attempts to contribute from people outside the specialized ingroup. This stuff is hard, what counts as a hypothesis test for instance? Should datasets be locked and each view counted as a hypothesis? That's a very reasonable debate.
- rscho 5y agoContribute what? Mathematically incorrect statements don't seem very useful to me... After cursory examination, I don't understand your point regarding the stackexchange link. As for hypothesis testing, I also fail to see how that is supposedly poorly defined.
- deepnotderp 5y agoSlide 12 onwards illustrates my regarding hypothesis testing in the sciences: https://indico.cern.ch/event/995950/attachments/2171998/3676039/slides.pdf https://indico.cern.ch/event/995950/attachments/2171998/3676... Say you have a dataset with several variables and you’re looking for correlations between them. If 20 different groups separately download the dataset and test hypotheses, should their p-values be adjusted for multiple hypothesis testing?
- rscho 5y agoOk, now it's clear. So yes I agree that controlling false discovery rate is an unsolved problem that p-value doesn't address. Yes of course applied stats are a kind of 'soft science', at least regarding the interpretation of results. Statistical theory on the other hand, is very well defined. So that doesn't justify considering assumptions made from erroneous conceptual understanding. This is where we disagree, I guess.
- tehjoker 5y agoI was reading the COVID-19 literature and this review was the best I found at elucidating the known pathophysiology so far. It indicated that part of the (very complex) syndrome was platelet release of 5-HT (serotonin). They speculated that SSRIs of some kind could help stem the dumping of 5-HT into the bloodstream. The disease evolves to different stages using different mechanisms at each stage, which explains why certain medications only seem to work at really specific stages of the disease. P. E. Marik, J. Iglesias, J. Varon, and P. Kory, “A scoping review of the pathophysiology of COVID-19,” Int J Immunopathol Pharmacol, vol. 35, p. 205873842110480, Jan. 2021, doi: 10.1177/20587384211048026. https://pubmed.ncbi.nlm.nih.gov/34569339/ https://pubmed.ncbi.nlm.nih.gov/34569339/ If someone knows a more recent review, this was almost a year ago (wow), I'd love to see it!
- mdp2021 5y agoAxios brief: https://www.axios.com/covid-study-fluvoxamine-antidepressant-20eb32f7-5103-4888-b196-3e902c047c98.html https://www.axios.com/covid-study-fluvoxamine-antidepressant... it also refer as the original article in the Lancet as https://www.thelancet.com/journals/langlo/article/PIIS2214-109X%2821%2900448-4/fulltext https://www.thelancet.com/journals/langlo/article/PIIS2214-1... -- Note: do not overlook > only one patient in the fluvoxamine died, compared to 12 in the control group
- po1nt 5y agoI'm not pharmacist or some medical expert but I feel like there is a new drug that promises Covid19 treatment every week.
- randcraw 5y agoBut few are pills. Most require daily injections for a week or more. That's a lot more inconvenient and (usually) more expensive, especially for folks who live far from a clinic.
- LatteLazy 5y agoHow effective are the vaccines again? >90% right?
- deleted 5y ago[deleted]
- freitasm 5y agoMeanwhile https://www.covid19treatmentguidelines.nih.gov/therapies/immunomodulators/fluvoxamine/ https://www.covid19treatmentguidelines.nih.gov/therapies/imm... "Further studies are needed to establish whether the anti-inflammatory effects of fluvoxamine observed in nonclinical studies also occur in humans beings and are clinically relevant in the setting of COVID-19."
- Traubenfuchs 5y agoLike any SSRI, Fluvoxamine can cause permanent sexual dysfunction. SSRI should not be used unless their potential benefit is greater than the potential risk of permanent sexual dysfunction. Even short term SSRI administration can be very uncomfortable and lead to short term SSRI discontinuation syndrome. I know doctors treat SSRI like „let’s try, might help, can’t hurt“ candy, but they really shouldn‘t.
- podgaj 5y agoIt is not permanent, the SD goes away after about a month of stopping prozac. It has a long half life so it can seem like forever though.
- ziml77 5y agoYou don't even have to stop taking it for that side effect to wear off. The amount of time it took for me to relieve sexual tension when I started on SSRIs was crazy. Many times I just gave up and tried again later. But it got better over the course of a few weeks and eventually got back to how I was before I started the SSRI. This isn't a guarantee that they will affect everyone the same way, but you can't judge SSRIs by the period when you're starting them.
- vernie 5y agoNow what to do about that pesky increased suicidality.
- dablweb 5y agoUh, didn't we know this like... more than a year ago?
- nikkinana 5y agoEnemas do the same thing
- taxyovio 5y agoBe aware that the said antidepressant is an SSRI, which has the potential to cause permanent sexual dysfunction (PSSD) [1]. It seems that we don’t quite understand how the drug works. Most doctors threw this condition out of the window by claiming SD is caused by depression. There have been some recent studies showing possible mechanisms behind it. Some manufacturers and healthcare organisations (NHS) are beginning to label this as a potential side effect. But in general it’s not well known. [1] https://rxisk.org/post-ssri-sexual-dysfunction-pssd/ https://rxisk.org/post-ssri-sexual-dysfunction-pssd/
- podgaj 5y agoI can tell you from personal use as someone with Bipolar Disorder, my ding-a-ling works fine before I start taking it and after the first week I have nothing but a wet noodle down there. So no, the SD is not caused by depression, it is caused by Prozac. The mechanism of action how this helps is probably so simple that people who have over complicated thoughts cannot see the answer. Serotonin is made from tryptophan by the TPH enzyme. But Tryprtophan is also turned into kynurenine by an enzyme called IDO. This kynurenine pathway is crucial to resolving inflammation and the IDO enzyme is directly activated by inflammation. When you take prozac so much serotonin builds up that it starts inhibiting the TPH enzyme and pushes more tryptophan down the kynurenine pathway and resolves inflammation. Depression in probably most of the cases is an inflammatory disorder, which is why prozac helps some people with depression. It has been shown that COVID-19 infection results in alterations of the kynurenine pathway. I will make a guess that prozac will end up helping some people but not everyone.
- podgaj 5y agoThe mechanism of action how this helps is probably so simple that people who have over complicated thoughts cannot see the answer. Serotonin is made from tryptophan by the TPH enzyme. But Tryprtophan is also turned into kynurenine by an enzyme called IDO. This kynurenine pathway is crucial to resolving inflammation and the IDO enzyme is directly activated by inflammation. When you take prozac so much serotonin builds up that it starts inhibiting the TPH enzyme and pushes more tryptophan down the kynurenine pathway and resolves inflammation. Depression in probably most of the cases is an inflammatory disorder, which is why prozac helps some people with depression. It has been shown that COVID-19 infection results in alterations of the kynurenine pathway. I will make a guess that prozac will end up helping some people but not everyone.
- yonaguska 5y agoFLCCC and doctors now labelled quacks have been pushing this for months. Clinical successes of alternative, outpatient treatments have been directly disparaged by the FDA. I have zero trust in the institutions meant to protect us. Dr. Pierre Kory has been using this for months to treat both long-covid patients as well as vaccine injured patients. I hate to bring this stuff up on a technical forum like this, but some very disgusting incentives are at play with our healthcare system and the pharmaceutical industry, that need correction.
- Jeema101 5y agoIf you are suggesting that there is a conspiracy to keep inexpensive drugs from being used to treat covid, then I would like to point out that corticosteroids - an inexpensive and widely available generic medication - are an accepted part of treatment for people hospitalized with covid, and has been for some time now. There is no conspiracy.
- yonaguska 5y agoCorticosteroids are not prophylactics. They also aren't something you take to prevent hospitalizations. I'm specifically talking about treatments that, if taken on early onset of symptoms, help prevent hospitalizations in the first place. Such treatments would have rendered the Emergency Use Authorization for novel expensive treatments, null and void. And I'm not alleging a conspiracy. I'm concerned that Trump's project warp speed created incentives to suppress cheap alternative treatments to expensive EAU treatments. I generally don't believe large conspiracies are that common. I do believe that poorly implemented incentives create conspiratorial appearing behavior with negative externalities. I personally know people that directly suffered from the costs of these poor incentives, one vaccine injured friend that doctors refused to acknowledge her injury was related to the vaccine, and thus forced to pay out of pocket for several cardiologist visits and depend on her own sleuthing to finally start recovering months later. She had sudden heart issues with POTs symptoms right after her second shot. Healthy late 20s. Side note: it's amazing to me that we are all of a sudden trusting big pharma...when two years ago, everyone knew the incentives were broken, that these same companies regularly compromised the integrity of doctors, regulatory committees, and media, all while creating health crises in the name of profit.
- ft35y 5y agoCovid news is propaganda. I suggest you all pick up a book on empathy on how to talk to marginalized communities that have dealt with state backed violence for decades. By participating in and distributing "covid news" you are perpetuating a harmful atmosphere to those attacked by the state. Trigger words include "covid", "covid-19", "masking", "vaccine mandate", "vaccine", "mask mandate", "lockdown", "stay at home orders" and more. Please exclude this harmful language from your vocabulary and please stop distributing "covid news" on hacker news.
- Kafkish 5y agoIsn't this the same class of drugs that's been associated with sexual dysfunction in both men and women? https://news.ycombinator.com/item?id=29024808 https://news.ycombinator.com/item?id=29024808
- sattoshi 5y agoAre these horse antidepressants by any chance?