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Cheap antidepressant shows promise treating early Covid-19

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Re: Cheap antidepressant shows promise treating early Covid-19

#181

Post by darkerside »

npunt wrote: post #57
darkerside wrote: post #24

Earlier quoted context omitted.

> When the DSMC met on Aug 5, 2021, it recommended that the TOGETHER trial stop randomly assigning patients to the fluvoxamine group, as this comparison had met the prespecified superiority criterion for the primary endpoint (prespecified superiority threshold 97·6%). This... is not how it's supposed to work.

Actually, it is. This is an adaptive clinical trial, meaning its part of the protocol to change when pre-set criteria are met. This is stated in the paper. There's a whole body of work on the ethics and statistics of adaptive clinical trials and when to stop them early if promising results are found. https://en.wikipedia.org/wiki/Adaptive_clinical_trial

https://academic.oup.com/jnci/article/104/18/1347/924103

> He also cautioned against “play the winner” designs that increase the number of patients being randomized to arms that show the best results in an interim analysis. “That is most often used in early phase trials, like a Phase I or early Phase II trial where you’re really trying to identify the best dose level; such trials tolerate bias pretty well,” Sietsema said. “But you wouldn’t use a play- the-winner model in a Phase III trial because the potential for bias could lead to a wrong decision and the FDA would object.”

That sums up my concerns pretty well. This is being presented as a phase III clinical trial demonstrating safety and efficacy. For the level of effect they are testing for, I don't see how an adaptive trial is appropriate here.

Re: Cheap antidepressant shows promise treating early Covid-19

#182

Post by ogwh »

fnord77 wrote: post #180
_ywdj wrote: post #44

From 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 jus…

my AD/immune system anecdote: I have an autoimmune disease. Some ADs make the disease flare up. Some (particularly tricyclics) improve the disease's symptoms.

Tricyclics (and tetracyclics) tend to be incredibly potent antihistamines, which may explain this.

Re: Cheap antidepressant shows promise treating early Covid-19

#183

Post by tzs »

useragent86 wrote: post #149
chris11 wrote: post #79

Earlier quoted context omitted.

> Why are people so crazy about this drug? It looks to be a combination of right wing political commentators and a fringe anti-vax group. https://www.forbes.com/sites/stevensalzberg/2021/08/30/no-iv... https://twitter.com/oneunderscore__/status/14310404563648102...

It's disturbing how this topic is treated like a tribalistic team sport. Comments like yours seem to follow "Rules for Radicals"[0], such as rules 5 and, especially, 13: "Ridicule is man's most potent weapon. There is no defense. It is almost impossible to counterattack ridicule. Also it infuriates the opposition, who then react to your advantage." "Pick the target, freeze it, personalize it, and polarize it." You pr…

Your reasoning would apply equally well to almost any acknowledgement that there are any differences at all between any two groups on any given subject.

Re: Cheap antidepressant shows promise treating early Covid-19

#184

Post by becuzThrowaway »

chiefalchemist wrote: post #145
onion2k wrote: post #47

Earlier quoted context omitted.

I 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.

It might not be an alternative drug but it's certainly an alternative narrative. The momentum for the jab is all but unstoppable at this point. The continued talk of jab passports, and such. Once a narrative becomes normalized it's difficult to change. Note: This isn't a political statement or criticism. It's Human Comms and Human Behaviour 101.

>This isn't a political statement or criticism. It's Human Comms and Human Behaviour 101.

Seems pretty political to me.

Re: Cheap antidepressant shows promise treating early Covid-19

#185

Post by lettergram »

wesleywt wrote: post #173
lettergram wrote: post #46

Glad 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...

There is no such thing as alternative medicine. If the drug is tested and found to be effective then it is medicine. But you must expect rigorous analysis and provide significant evidence to support you claims. This is how it works. If you can't handle it then you are in 'alternative' medicine, which is not real.

I think you misread, I said “alternative treatments”, there definitely can be alternative treatment methods to the main method. For instance, some people can’t take Tylenol, so they take Ibuprofen. It’s an alternative treatment to handle pain.

I understand what you’re referring in terms of “alternative medicine”, but that’s it’s own genre.

Re: Cheap antidepressant shows promise treating early Covid-19

#186

Post by mionhe »

wesleywt wrote: post #173
lettergram wrote: post #46

Glad 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...

There is no such thing as alternative medicine. If the drug is tested and found to be effective then it is medicine. But you must expect rigorous analysis and provide significant evidence to support you claims. This is how it works. If you can't handle it then you are in 'alternative' medicine, which is not real.

OP said alternative treatment. Presumably they meant an alternative to the treatments currently en vogue versus faith healing or some such thing. Also, it sounds like they are involved with people who are working on providing evidence...I'm not clear what is causing your criticism.

Re: Cheap antidepressant shows promise treating early Covid-19

#187

Post by dmschulman »

lettergram wrote: post #185
wesleywt wrote: post #173

Earlier quoted context omitted.

There is no such thing as alternative medicine. If the drug is tested and found to be effective then it is medicine. But you must expect rigorous analysis and provide significant evidence to support you claims. This is how it works. If you can't handle it then you are in 'alternative' medicine, which is not real.

I think you misread, I said “alternative treatments”, there definitely can be alternative treatment methods to the main method. For instance, some people can’t take Tylenol, so they take Ibuprofen. It’s an alternative treatment to handle pain. I understand what you’re referring in terms of “alternative medicine”, but that’s it’s own genre.

"Alternative treatment" implies an unapproved, off-label use. Maybe you meant "promising therapeutic" or something along those lines? Throwing around the term "alternative" is dicey, especially in a world where people take advice about COVID vaccines and "alternative treatments" from podcasts hosted by former comedians.

Once enough studies have been done, this off-label use for fluvoxamine will likely be blessed by the agencies that regulate these sorts of things and at that point it will become an approved treatment for long COVID symptoms. Most things spoken of as "alternative treatments" don't even get to the first stage of this process (since they can't be substantiated with evidence).

Re: Cheap antidepressant shows promise treating early Covid-19

#188

Post by woodruffw »

bsaul wrote: post #88
_huayra_ wrote: post #45

Earlier quoted context omitted.

It'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.

i 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.

As 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.

Re: Cheap antidepressant shows promise treating early Covid-19

#189

Post by woodruffw »

toomanybeersies wrote: post #95
_huayra_ wrote: post #45

Earlier quoted context omitted.

It'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.

Why not both? Vaccination isn't a silver bullet.

Nobody said it is. If your medical provider determines that you need both, then you should probably do that.

Re: Cheap antidepressant shows promise treating early Covid-19

#190

Post by woodruffw »

tinus_hn wrote: post #156
_huayra_ wrote: post #45

Earlier quoted context omitted.

It'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.

One difference is that ivermectin has been safely used for many years while mRNA vaccines are rather new.

I posted this w/r/r SSRIs below, but it’s also true for Ivermectin: the development timeline aligns largely with that of mRNA vaccines.

Vaccinated diseases, more so than other medical ailments, are subject to existing technology being “good enough” until it suddenly isn’t anymore. But that doesn’t mean new entries are untested; it means the economic envelope in which it makes sense to test them is just a different shape.

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