The FDA Has Punted Decisions About Luvox Prescription To The Deepest Recesses Of The Human Soul

https://astralcodexten.substack.com/p/the-fda-has-punted-decisions-about

I.

Here’s my pitch for fluvoxamine (Luvox) for COVID.

In the midst of all the hype about ivermectin and hydroxychloroquine, scientists put together the giant 4,000-person TOGETHER trial, intended to test all these exciting COVID early treatments. You know what happened next: ivermectin and hydroxychloroquine crashed and burned.

But a different drug, the SSRI antidepressant fluvoxamine, actually did really well! It decreased COVID hospitalizations by about 30% - not the perfect cure rate the rumors attributed to ivermectin, but a substantial decrease. Given the size and professionalism of this study, and another smaller one that also got positive results, I and many others take Luvox pretty seriously. At this point I’d give it 60-40 it works.

Can you prescribe a medication when you’re only 60% confident in it? There’s some thorny philosophical issues around this, but I think in the end you have to compare risks and benefits.

What are the risks? Like every medication, including Tylenol, aspirin, etc, Luvox has some common minor side effects and some rare major ones. But let’s step back a second. Fluvoxamine is a bog-standard SSRI. Its side effects are generic SSRI side effects. We give SSRIs to 30 million people a year, or about 10% of all Americans. As a psychiatrist, I’m not supposed to say flippant things like “we give SSRIs out like candy”. We do careful risk-benefit analysis and when appropriate we screen patients for various risk factors. But after we do all that stuff, we give them to 10% of Americans, compared to 12% of Americans who got candy last Halloween. So you can draw your own conclusion about how severe we think the risks are.

For some reason the same experts who don’t mind prescribing SSRIs when people have mild depression freak out about prescribing them when they’re the only evidence-based oral medication for a deadly global pandemic. “What about SSRI withdrawal?”, they ask. After a ten day course? On 100 mg imipramine-equivalent dose? Minimal. “What about long QT syndrome?” The VA system took 35,000 high-risk older patients off of an unusually-likely-to-cause-QT-syndrome SSRI in 2011, and were unable to find any evidence that this prevented even a single case of the syndrome, let alone any negative outcome!