Meta-Analytic Super-Spreader

November, 3, 2020 | 12 Comments

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    The Lancet Psychiatry
    @TheLancetPsych
    In recognition of #PeerRevWeek20 we would like to say thank you to our reviewers for their essential role in maintaining the advancement of science and medicine through helping us to identify the most robust and impactful work #TrustInPeerReview https://hubs.li/H0wB2cg0
    GIF
    9:04 PM · Sep 21, 2020·Twitter Web App

    re the last sentence in DH JG article

    The statement that ‘finally we will explicitly ask reviewers if they have concerns….’ is astonishing. That it hasn’t been taken for granted that they would raise concerns is incredible ,that the requirement even needs to said undermines trust in anything reviewers and the journal has published and crucially so been propagated around other academics and whoever else reads their publications. Have reviewers actually been reporting concerns themselves though – and had them ignored or suppressed for whatever reason?
    Must say how glad I am that DH and J G have highlighted the fact that people can be forced against their will to take medications which have the potential for causing serious harm and deaths – let alone breach their human rights There is also the fact th people are coerced against their will to take these medications by the overt or covert threat of being incarcerated if they refuse. Where of course long lasting depot injections can be forcibly given.

  2. “By contrast giving treatments open-label slows everything down by leading us up blind alleys while playing roulette with our patients’ lives. I hope this message is clear enough to help sort out this muddled thinking.”

    Trial drugs should be used to treat all coronavirus hospital patients, suggests Tony Blair

    ‘This is not the only politician this year to have expressed opinions regarding unproven therapies and doubtless not the last’

    https://www.telegraph.co.uk/news/2020/11/02/trialdrugs-should-used-treat-coronavirus-hospital-patients-suggests/

    Meta-Analysis, dubious Data-Sharing Agencies, avoidance-seeking peer-reviewers and death-defying accumulations lead the way like Psychiatric Whatnots and Covid Queens….

    https://www.youtube.com/watch?v=6Xw8tkDk5uY&feature=emb_logo

    Conclusion and implications for research and policy

    https://www.bmj.com/content/351/bmj.h4320

    Contrary to the original report by Keller and colleagues, our reanalysis of Study 329 showed no advantage of paroxetine or imipramine over placebo in adolescents with symptoms of depression on any of the prespecified variables. The extent of the clinically significant increases in adverse events in the paroxetine and imipramine arms, including serious, severe, and suicide related adverse events, became apparent only when the data were made available for reanalysis. Researchers and clinicians should recognise the potential biases in published research, including the potential barriers to accurate reporting of harms that we have identified. Regulatory authorities should mandate accessibility of data and protocols.

    As with most scientific papers, Keller and colleagues convey an impression that “the data have spoken.” This authoritative stance is possible only in the absence of access to the data. When the data become accessible to others, it becomes clear that scientific authorship is provisional rather than authoritative.

    Study 329 was ghost-written, as are all trials of all drugs you might take. The data on what happened to the teenagers in this trial are inaccessible, as are the data from all trials of all drugs you might take. Children of the Cure tells the story of the only pharma company trial where independent researchers have had access to the data and the struggle to publish their findings—a struggle in which medical journals were as difficult as Big Pharma.

    https://samizdathealth.org/children-of-the-cure/

    Children of the Cure tells the story of the only Medical Study that has two publications in the academic literature—telling precisely the opposite story—and how no one is bothered by this.

    Will the dilettantes climb-down, climb-up, conk-out…

  3. Hopefully this will teach someone in the medical-research world a lesson. Never write a paper based on data that you aren’t allowed to see. Sounds drop-dead obvious, doesn’t it? My grandma told me the same thing: Don’t buy a pig in a poke. (Poke being an old hillbilly word for a sack.) And she didn’t have a PhD.

    But especially in psychiatry, there has been a pile of recent medical research that’s based on private insurance databases. In particular, the key peer-reviewed articles that allegedly undermined the teen-suicide warnings on antidepressants have all been based on insurance-claims data. “Proprietary” data that no one else can see.

    They may be almost as bad as Desai’s work. Granted, the insurance data probably exists. Maybe the authors did the data analysis themselves; maybe the insurance company did it for them. But either way, their work cannot be checked. Anyone who doubts their conclusions will just have to take it on faith: Here is what the data said. (And you’d be hard pressed to find a more polluted form of data!)

    It gets worse, however. Even when a paper is based on actual patient research, it is often done by drug-company contractors. The official authors of the paper may never have laid eyes on a single subject, and only seen the official “results” after they’ve been thoroughly massaged by drug-company employees. So I guess we shouldn’t be too surprised when leading experts and major medical journals are taken for a ride by a brash young huckster like Desai with vague but exciting stories about Big Data.

  4. Fire and Brimstone –

     I suspect that you could write a brilliant article about ghost writing and kindred behaviour, but this is not it.  In my editorial career I have always been suspicious of the pharmaceutical industry – and the question of ghost writing was raised during my editorship of the Lancet – but I have found that medical readers do not relish the fire and brimstone approach.  My external reviewer, an academic child psychiatrist, took a similar view.  He reckoned that the review should be rewritten, with evidence for and against throughout and minus the direct accusations of immoral behaviour.  Whatever you do, I think that you should describe and leave to others to judge.

    https://davidhealy.org/neo-culturalism/

    Time to Re-Watch the talk in Lyon –

    David Healy – GSK 329 Talk – Lyon, October 15th, 2019 (sous-titres ENG et FR)

    https://www.youtube.com/watch?time_continue=1&v=ZrYPYlXA0b4&feature=emb_logo

    Whatever you think is going on, a smelly figure (breaking bad) with warts and a personality was making the call at the other end of the correspondence. If you were disgusted, you knew what face to put on the voodoo doll as you prepared the pins.

    We now have platforms, where we once had bottoms.  A topic gets picked by a company like Frontiers who own a platform. They look around for editors to help put together an issue on the now sure-fire topic like antidepressants in children.

    But at the moment only one set of interests get heard. …
     

  5. Clinical Research Facility
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    You are here: Home / Research Themes / Theme Leads / Profile: Andrea Cipriani
    Profile: Andrea Cipriani
    NIHR Research Professor, University of Oxford

    Cross-cutting theme lead: Informatics / Digital health

    Email: andrea.cipriani@psych.ox.ac.uk

    Phone: 01865 618228

    ‘My main research interest is evidence-based mental health and precision psychiatry. My research focuses on the evaluation of pharmacological, psychological and psychosocial interventions, mainly about major depression, bipolar disorder and schizophrenia. I have carried out many systematic reviews, meta-analyses and randomised controlled trials in psychopharmacology, however in the past few years I have been also investigating relevant issues in epidemiological psychiatry and public health, like patterns of drug consumption, risk of serious adverse events (most of all, suicide and deliberate self harm) and implementation of treatment guidelines.’
    Andrea Cipriani may be charming as so many of those who who have committed serious wrong doing often are – but if he cannot admit to his errors and retract a publication can we trust there is not or won’t be anything else in the cupboard now or in future. It is the sign of a ‘good’ scientist’ that errors can be admitted and new evidence pursued to correct them.

    Along with many others A C’s hospital has set up the Young Persons Advisory Project. to comply with cynical PPI (Patient and Public Involvement) Which, in various guises have fooled more than groups of young people, who thought they could make a difference
    As we know these projects give a convenient gloss on research but young people are being duped with fluffy days out and deliberate evasion of a duty to give them accurate information about the scandals historical and current taking place in research. How many will be told about Study 29…

    The enthusiasm they start out with is admirable but it is simply corrupt to mis-inform them about all aspects of research.
    eg
    NeurOx Young People’s Advisory Group

    We are a group of young people (between 14 and 18 years old) who work with the Neuroscience, Ethics and Society (NEUROSEC) team to help develop methods for working with young people to better understand their views.

    We meet once or twice per term, normally on Saturdays in central Oxford. In between meetings, we keep in touch via email or other online platforms.

  6. Debunking the loss of the Committee on Publication Ethics (COPE) moral compass: conspiracy theory, or genuine cause for concern?
    May 2019Eubios journal of Asian and international bioethics: EJAIB 29(3):99-109
    Authors:
    Jaime A. Teixeira da Silva
    67.31Retired / independent

    The natural instinct for members of the Committee on Publication Ethics (COPE), which now number almost 12,200, as well as academia, is to assume that this organization works under strict and clearly defined ethical parameters, with a solid vision, and an independent mandate that is not influenced by power, think tanks, or partisan interests. Naturally, whistle-blowing and science shaming are not practices that one would usually associate with an ethics organization like COPE, because they involve ethically and morally questionable practices. Despite this, ethical borders have become blurred between the objectives of Retraction Watch and PubPeer, two self-moderated science watchdogs that rely heavily on these questionable practices, in their efforts to grow and survive, and the values espoused by COPE. A Retraction Watch post, in which the former COPE Chair, Virginia Barbour (2012-2017), made a claim of apparent harassment, is the most striking example of the dangers when collaboration may take place between science-shaming websites, and an ethics organization, COPE. These bonds appear to have been in development for a number of years already, with the inclusion of Elizabeth Wager, the former COPE Chair (2009-2012), as a director of The Center for Science Integrity Inc. (CSI), Retraction Watch’s parent organization. Retraction Watch was financed by, among other groups, the Laura and John Arnold Foundation (LJAF), whose leader, John Arnold, an ex-Enron trader, declared a “war on bad science”, which may naturally include the destruction of aspects of science as well. Retraction Watch embraces several infamous pseudonymous personas under the broad umbrella of freedom of speech, liaising thereby with PubPeer. There is no doubt that errors in the literature need correcting, but this apparent connection with COPE raises questions about the basic ethical foundation of this relationship. Are scientists to embrace this bond between COPE and science watchdogs and pseudonymous whistle-blowers as the new normal in the correction of the scientific literature? This opinion piece puts forward arguments why the author believes that the ethical compass of COPE has become skewed.

  7. – we refer to it as a tsunami –

    recovery&renewal Retweeted

    Miranda Levy
    @mirandalevycopy

    Maybe withdrawals from antidepressants aren’t so ‘mild and self-limiting’ after all…

    @recover2renew @Altostrata @Mad_In_America @markhoro @wendyburn @rcpsych

    ‘All hell broke loose’: The truth about coming off of anti-depressants

    There is growing evidence that millions are suffering distressing side effects of withdrawal, putting pressure on doctors to act

    By Miranda Levy8

    November 2020 • 5:00pm

    https://www.telegraph.co.uk/health-fitness/mind/broke-loose-truth-coming-anti-depressants/

    Today sees the publication of a report in the journal Therapeutic Advances In Psychopharmacology, entitled The Patient Voice on Prescribed Dependence. It finds that 82 per cent of respondents reported the onset of new and unpleasant symptoms on stopping their antidepressants.

    Until very recently, the psychiatric “establishment” insisted that withdrawals from antidepressants were “mild and self-limiting over about one week”. In 2018, the Royal College of Psychiatrists sent a letter to a newspaper stating that: “In the vast majority of patients, any unpleasant symptoms… have resolved within two weeks of stopping treatment.”

    There was an outcry. Formal complaints were made and signatories – including Dr Wendy Burn, the outgoing President of the Royal College of Psychiatrists – were attacked on social media.

    “I started to realise that I was wrong and there was a big problem,” says Dr Burn, who also works as a consultant old age psychiatrist in Leeds.

    Why had this taken so long? Part of the problem is a lack of data –

    “We tend to work with evidence,” says Dr Burn.

    recovery&renewal Retweeted

    James Moore
    @jf_moore

    100-year old woman, prescribed #antidepressants. Why? Because of loneliness and isolation. What’s that going to do for her other than give her adverse effects to deal with on top of everything else? This is no way to respond to COVID isolation

    https://metro.co.uk/2020/11/08/doreen-100-wants-to-die-after-eight-months-isolated-in-care-home-13558744/

    Royal College of Psychiatrists
    @rcpsych

    “All the indications are that there is going to be a big surge – we refer to it as a tsunami – of mental illness as a result of the pandemic.” @DrAdrianJames and @AgnesAyton in @Telegraph

    https://www.telegraph.co.uk/news/2020/11/08/exclusive-number-people-seeking-help-suicidal-thoughts-has-tripled/

    louis appleby
    @ProfLAppleby

    We need to acknowledge the anxiety people feel in a pandemic without alarming predictions on mental health that could add to risk. So please, no more “tsunami” or “suicide epidemic”.

    https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30484-3/fulltext

    Need for ‘Caution’ …

    • Anne Guy is a psychotherapist and the co-ordinator for the secretariat of the All-Party Parliamentary Group for Prescribed Drug Dependence.
      Marion Brown is the originator of the Scottish Petition.
      Stevie Lewis is the originator of the Welsh Petition.

      recovery&renewal
      @recover2renew
      ·
      This is the newly published #PatientVoice research quoted in @Telegraph
      9 November 2020:

      The ‘patient voice’: patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition

      Anne Guy, Marion Brown, Stevie Lewis

      First Published November 9, 2020

      https://journals.sagepub.com/doi/10.1177/2045125320967183#articleShareContainer

      Conclusion

      We report here on a cohort of patients who were significantly affected by withdrawal from antidepressant (and other prescribed psychotropic) medication and found the response of the health system to their condition inadequate and distressing.

      This inadequate response led to misdiagnosis, investigations and further treatment, and caused many respondents to lose faith in the health system and seek help in unregulated peer-led services. It is hoped that lessons can be taken from these experiences and, in line with the recent PHE recommendations, remediations should include: updated guidance about identification of withdrawal symptoms and optimal tapering schedules, which should be widely disseminated and integrated into physician education; dedicated services for those with prescribed drug dependence and withdrawal, including a national help line and appropriately trained staff in primary and secondary care; and an improved feedback mechanism for patients.

      In this way, patients currently suffering from dependence and withdrawal issues from antidepressants, and other prescribed psychotropic medication, as well as the large group of patients at risk of these problems, can have their health needs managed appropriately by health services, rather than compounded by them.

  8. Lets hopethe wonderful cmpaignres who have forced this investigation to take place – will demand to knowwhat medications their relatives were put on. My old friend before the pandemic was given antipsychotics without anybody being informed or consenting because she was afraind and distressed after being hospitalised for a heart attack and kept calling out for her sister – it was given deliberately to knock her out. as ‘she was disaturvbing other patients’.. Let’s not pretend there was no intention to allow older frail people to die
    Take me to All 4
    Menu
    22 Oct 2020
    Police investigating care home deaths in Scotland
    Ciaran Jenkins
    Scotland Correspondent
    Channel 4 News can reveal that a major police investigation into care home deaths is up and running in Scotland, with officers beginning to gather evidence on all notified care home deaths.

    We also understand that some care workers have already spent many hours being questioned by police, which some in the care sector say is causing “extreme distress” among carers trying to prevent a second wave of deaths.

  9. NICE proposes simplifying how medicines and medical …www.nice.org.uk › news › article › nice-proposes-simpl…
    9 Oct 2020 — The consultation on the proposals runs until 19 November. A public consultation on the case for change to NICE’s methods for health technology assessment will begin in November 2020. This will be followed by a separate public consultation on the case for change to its processes in February and March 2021.

    NICE consults on looking beyond RCTs when evaluating drugs and devices
    BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4326 (Published 09 November 2020)

    Jacqui Wise
    The National Institute for Health and Care Excellence (NICE) is proposing placing more emphasis on “real world evidence” when it develops guidance on health technologies, as well as considering additional factors such as the severity of a condition or whether a treatment can reduce health inequalities.

    NICE has launched a public consultation that sets out the case for changing the methods it uses to develop guidance on drugs, medical devices, and diagnostics.1 The review was first announced in July 2019 but has been delayed because of covid-19.2

    The consultation document says that there should be no change to the general preference for randomised controlled trials (RCTs) to inform estimates of treatment effects but that there should be “an emphasis on the role of a comprehensive evidence base, including non-RCTs and real world evidence.” Real world evidence includes evidence from observational studies, patient registries, electronic health records, and other sources beyond RCTs.

  10. The head of the MHRA which has been so culpable in obscuring, to say the least, adverse effects of ADs and other drugs ,has been on the news bulletins over the last few days to absolutely assure the population in UK that their overseeing of the covid vaccine will be watertight -backed up by the health spokesperson who gives nightly bulletin. They were probably managing the doubt raised by the following advert. Why otherwise such a focus on the potential number of adverse effects expected?

    2020/S 207-506291

    Contract award notice

    Results of the procurement procedure

    Short description:
    The MHRA urgently seeks an Artificial Intelligence (AI) software tool to process the expected high volume of Covid-19 vaccine Adverse Drug Reaction (ADRs) and ensure that no details from the ADRs’ reaction text are missed.

    II.1.6)
    Information about lots
    This contract is divided into lots: no
    II.1.7)
    Total value of the procurement (excluding VAT)
    Value excluding VAT: 1 500 000.00 GBP
    II.2)
    Description
    II.2.2)
    Additional CPV code(s)
    48000000 Software package and information systems
    II.2.3)
    Place of performance
    NUTS code: UK UNITED KINGDOM
    II.2.4)
    Description of the procurement:
    The MHRA urgently seeks an Artificial Intelligence (AI) software tool to process the expected high volume of Covid-19 vaccine Adverse Drug Reaction (ADRs) and ensure that no details from the ADRs’ reaction text are missed.

    II.2.5)
    Award criteria
    Price
    II.2.11)
    Information about options
    Options: no
    II.2.13)
    Information about European Union funds
    The procurement is related to a project and/or programme financed by European Union funds: no
    II.2.14)
    Additional information
    Section IV: Procedure

    IV.1)
    Description
    IV.1.1)
    Type of procedure
    Award of a contract without prior publication of a call for competition in the Official Journal of the European Union in the cases listed below
    The procurement falls outside the scope of application of the directive
    Explanation:
    For reasons of extreme urgency under Regulation 32(2)(c) related to the release of a Covid-19 vaccine MHRA have accelerated the sourcing and implementation of a vaccine specific AI tool.

    Strictly necessary — it is not possible to retrofit the MHRA’s legacy systems to handle the volume of ADRs that will be generated by a Covid-19 vaccine. Therefore, if the MHRA does not implement the AI tool, it will be unable to process these ADRs effectively. This will hinder its ability to rapidly identify any potential safety issues with the Covid-19 vaccine and represents a direct threat to patient life and public health.

    Reasons of extreme urgency — the MHRA recognises that its planned procurement process for the SafetyConnect programme, including the AI tool, would not have concluded by vaccine launch. Leading to a inability to effectively monitor adverse reactions to a Covid-19 vaccine.

    Events unforeseeable — the Covid-19 crisis is novel and developments in the search of a Covid-19 vaccine have not followed any predictable pattern so far.

    IV.1.3)
    Information about a framework agreement or a dynamic purchasing system
    IV.1.8)
    Information about the Government Procurement Agreement (GPA)
    The procurement is covered by the Government Procurement Agreement: yes
    IV.2)
    Administrative information
    IV.2.8)
    Information about termination of dynamic purchasing system
    IV.2.9)
    Information about termination of call for competition in the form of a prior information notice
    Section V: Award of contract

    A contract/lot is awarded: yes
    V.2)
    Award of contract
    V.2.1)
    Date of conclusion of the contract:
    14/09/2020
    V.2.2)
    Information about tenders
    Number of tenders received: 1
    The contract has been awarded to a group of economic operators: no
    V.2.3)
    Name and address of the contractor
    Official name: Genpact (UK) Ltd
    Town: London
    NUTS code: UK UNITED KINGDOM
    Country: United Kingdom
    The contractor is an SME: no
    V.2.4)
    Information on value of the contract/lot (excluding VAT)
    Total value of the contract/lot: 1 500 000.00 GBP
    V.2.5)
    Information about subcontracting
    Section VI: Complementary information

    VI.5)
    Date of dispatch of this notice:
    19/10/2020

  11. 2 of 2
    PIMsPlus: Medication Reference Site | Dr. David Healy

    Putting the horse before the cart:- This brilliant project PIMs will also probably have the knock on effect of alerting others in elderly peoples’ circles of the need to be vigilant Hope it spreads further and wider quickly when the need has an additional need now Covid is rampant ie many , but certainly not all, will be in very vulnerable positions as Vaccines are being prioritised for older people They will be in fairly powerless situations if they decline, Who knows whether proper assessments of the effects of medications will be carried out. I am pretty cynical about the reason they have been prioritised – huge numbers of people will be being trialled without proper safeguards Or has the government and medicos found a conscience or more likely know the cat is out of the bag so the public won’t keep quiet any longer about deaths of elderly people.

    Should Fluvoxaline be on the PIMs list?

    ‘Filling a Niche’
    THURSDAY, Nov. 12, 2020 — The antidepressant drug fluvoxamine — best known by the brand name Luvox — may help prevent serious illness in COVID-19 patients who aren’t yet hospitalized, a new study finds.

    The study included 152 patients infected with mild-to-moderate COVID-19. Of those, 80 took fluvoxamine and 72 took a placebo for 15 days.

    By the end of that time, none of the patients who took the drug had seen their infection progress to serious illness, compared with six (8.3%) of the patients who took the placebo, according to researchers at Washington University School of Medicine in St. Louis.

    “The patients who took fluvoxamine did not develop serious breathing difficulties or require hospitalization for problems with lung function,” said first author Dr. Eric Lenze, professor of psychiatry.

    “Most investigational treatments for COVID-19 have been aimed at the very sickest patients, but it’s also important to find therapies that prevent patients from getting sick enough to require supplemental oxygen or to have to go to the hospital. Our study suggests fluvoxamine may help fill that niche,” Lenze noted in a university news release.

    Fluvoxamine — widely used to treat depression, obsessive-compulsive disorder and social anxiety disorder — is a type of drug called a selective serotonin-reuptake inhibitor (SSRI). This class of drugs also includes medicines such as Prozac, Zoloft and Celexa.

    But unlike other SSRIs, fluvoxamine has a strong interaction with a protein called the sigma-1 receptor, which helps regulate the body’s inflammatory response.

    “There are several ways this drug might work to help COVID-19 patients, but we think it most likely may be interacting with the sigma-1 receptor to reduce the production of inflammatory molecules,” explained study senior author Dr. Angela Reiersen, associate professor of psychiatry.

    “Past research has demonstrated that fluvoxamine can reduce inflammation in animal models of sepsis, and it may be doing something similar in our patients,” she said in the release.

    By reducing inflammation, fluvoxamine may prevent a hyperactive immune response in COVID-19 patients. That, in turn, may decrease their risk of serious illness and death, Reiersen said.

    “Our goal is to help patients who are initially well enough to be at home and to prevent them from getting sick enough to be hospitalized,” Dr. Caline Mattar, assistant professor of medicine in the Division of Infectious Diseases, said in the release. “What we’ve seen so far suggests that fluvoxamine may be an important tool in achieving that goal.”

    The researchers said they plan to begin such a study in the next few weeks and it will include patients from across the United States.
    The preliminary study was published online Nov. 12 in the Journal of the American Medical Association.

    and

    KANSAS CITY LAWYERS | DANGEROUS DRUGS
    Luvox (fluvoxamine maleate) is an SSRI (selective serotonin reuptake inhibitor). It has been primarily used to treat Obsessive Compulsive Disorder (OCD) and Social Anxiety Disorder (SAD) . It is marketed under the names:
    Luvox
    Luvox CR, manufactured by Jazz pharmaceuticals, has recently come under fire from the FDA for it deceptive marketing practices . In 2010, the FDA warned Jazz Pharmaceuticals that a patient brochure for Luvox CR was “false or misleading” because it suggested that Luvox was “safer and more effective than has been demonstrated.”

    There is a multitude of adverse effects, many induce the sort of symptoms many older people experience anyway
    https://www.medicines.org.uk/emc/product/2416/smpc#gref

    This is the only para to warn elderly peopleFluvoxamine 100mg Film-Coated Tablets
    Wockhardt UK Ltd

    Fluvoxamine 100mg Film-Coated Tablets

    Adults When is the cut off for people to be classed as elderly
    The recommended dose is 100mg daily. Patients should start on 50 or 100mg, given as a single dose in the evening. Dosage should be reviewed and adjusted if necessary within three to four weeks of initiation of therapy and thereafter as judged clinically appropriate. (Are GPs to be trusted to do this? in home visits/in care homes?)

    Adults
    Withdrawal symptoms seen on discontinuation of fluvoxamine:

    Abrupt discontinuation should be avoided. When stopping treatment with fluvoxamine the dose should be gradually reduced over a period of at least one or two weeks in order to reduce the risk of withdrawal reactions (see sections 4.4 and 4.8). If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose, but at a more gradual rate.

    Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (suicide-related events). This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs. It is general clinical experience that the risk of suicide may increase in the early stages of recovery.

    Other psychiatric conditions for which fluvoxamine is prescribed can also be associated with an increased risk of suicide-related events. In addition, these conditions may be co-morbid with major depressive disorder. The same precautions observed when treating patients with major depressive disorder should therefore be observed when treating patients with other psychiatric disorders.

    A meta-analysis of placebo-controlled clinical trials of antidepressant drugs in adult patients with psychiatric disorders showed an increased risk of suicidal behaviour with antidepressants compared to placebo in patients less than 25 years old.

    Geriatric population:
    Data in elderly subjects give no indication of clinically significant differences in normal daily dosages compared to younger subjects. However, upward dose titration should be done slower in the elderly, and dosing should always be done with caution.
    Elderly people can obviously suffer from any of the adverse effects – including suicidal thoughts (and When is the objectionable label Geriatric going to be dropped altogether ?- )

    And of course on Rxisk
    DRUG SEARCH
    Drug Interaction Checker

    fluvoxamine
    Search
    Showing results for: fluvoxamine
    DRUG INTERACTION163
    DEPRESSION74
    ANXIETY73
    DRUG INEFFECTIVE72
    SOMNOLENCE67
    SEROTONIN SYNDROME66
    NAUSEA63
    COMPLETED SUICIDE61
    PYREXIA59
    SUICIDAL IDEATION59
    TREMOR58
    INSOMNIA55
    DIZZINESS54
    FATIGUE51
    HYPERHIDROSIS49
    CONDITION AGGRAVATED45
    HEADACHE44
    MALAISE43
    SUICIDE ATTEMPT42
    ASTHENIA41
    BLOOD CREATINE PHOSPHOKINASE INCREASED41
    AGITATION40
    OVERDOSE40
    VOMITING39
    FALL37
    CONVULSION35
    DIARRHOEA35
    LOSS OF CONSCIOUSNESS35
    DYSPNOEA34
    PAIN34
    CONFUSIONAL STATE32
    DRUG TOXICITY31
    ELECTROCARDIOGRAM QT PROLONGED31
    OBSESSIVE-COMPULSIVE DISORDER31
    PNEUMONIA31
    RESTLESSNESS31
    ALANINE AMINOTRANSFERASE INCREASED30
    TOXICITY TO VARIOUS AGENTS30
    AGGRESSION29
    FEELING ABNORMAL29
    NEUROLEPTIC MALIGNANT SYNDROME29
    INTENTIONAL OVERDOSE28
    CARDIO-RESPIRATORY ARREST27
    RASH27
    OFF LABEL USE26
    WEIGHT INCREASED26
    CHEST PAIN25
    RHABDOMYOLYSIS25
    TACHYCARDIA25
    ASPARTATE AMINOTRANSFERASE INCREASED24
    DELIRIUM24
    DRUG WITHDRAWAL SYNDROME24
    IRRITABILITY24
    SYNCOPE24
    DRUG LEVEL INCREASED23
    RENAL FAILURE ACUTE23
    AMNESIA22
    HYPOTENSION22
    MEMORY IMPAIRMENT22
    ABNORMAL BEHAVIOUR21
    ANAEMIA21
    DEPRESSED LEVEL OF CONSCIOUSNESS21
    OEDEMA PERIPHERAL21
    CHILLS20
    CONSTIPATION20
    GAIT DISTURBANCE20
    AKATHISIA19
    ALTERED STATE OF CONSCIOUSNESS19
    BACK PAIN19
    COMA19
    DEATH19
    DECREASED APPETITE19
    DIABETES MELLITUS19
    DISORIENTATION19
    DRUG ABUSE19
    DYSKINESIA19
    HYPERTENSION19
    MULTIPLE DRUG OVERDOSE INTENTIONAL19
    PARAESTHESIA19
    PSYCHOTIC DISORDER19
    ARTHRALGIA18
    BLOOD LACTATE DEHYDROGENASE INCREASED18
    MYALGIA18
    MYOCLONUS18
    DISTURBANCE IN ATTENTION17
    MUSCLE RIGIDITY17
    WEIGHT DECREASED17
    HYPOAESTHESIA16
    HYPOKALAEMIA16
    INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION16
    PRURITUS16
    PULMONARY OEDEMA16
    TREATMENT NONCOMPLIANCE16
    ABDOMINAL PAIN15
    ABDOMINAL PAIN UPPER15
    BLOOD PRESSURE DECREASED15
    BLOOD PRESSURE INCREASED15
    COUGH15
    DEHYDRATION15
    HEART RATE INCREASED

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