[HN Gopher] Fluoxetine promotes metabolic defenses to protect fr...
___________________________________________________________________
Fluoxetine promotes metabolic defenses to protect from sepsis-
induced lethality
Author : bookofjoe
Score : 130 points
Date : 2025-02-17 13:02 UTC (9 hours ago)
(HTM) web link (www.science.org)
(TXT) w3m dump (www.science.org)
| robertpohl wrote:
| A recent study published in Science Advances reveals that
| fluoxetine, a commonly prescribed antidepressant, offers
| protective benefits against sepsis. The research demonstrates
| that fluoxetine enhances interleukin-10 (IL-10)-dependent
| metabolic defenses, leading to improved survival rates in sepsis-
| induced disease models. This protective effect is achieved
| through multiple mechanisms, including antimicrobial properties
| and modulation of inflammatory responses. The findings suggest
| that fluoxetine's anti-inflammatory and metabolic effects could
| be harnessed as a therapeutic strategy for sepsis.
|
| Sepsis is a life-threatening condition that occurs when the
| body's response to an infection goes out of control, leading to
| widespread inflammation, tissue damage, and organ failure. It
| happens when the immune system, instead of fighting off the
| infection, starts attacking the body's own tissues.
| Me000 wrote:
| How would this effect gut bacteria?
| meindnoch wrote:
| Gut bacteria will be happy, because their host didn't die from
| sepsis.
| short_sells_poo wrote:
| You are technically correct (the best kind of correct), but I
| guess parent was asking whether this has any anti-bacterial
| side effects that might affect the gut flora. I'm wondering
| about this as well. The drug in question isn't an anti-biotic
| per-se, it doesn't help fight sepsis by making your body even
| more indiscriminately angry at bacteria - quite the opposite.
| Based on that, my suspicion is that the gut flora would not
| be affected directly, and would be happy on the basis of the
| host itself surviving the sepsis.
| metalman wrote:
| gut bacteria operate under the assumption that even if there
| host dies, in very many cases the host will be the victim of a
| preditor or a scavenger, and just hitches a ride up or down.the
| food chain, perfectly happy taking 100 bilion to to 1 odds on
| making it to the next perfect host bah!, its not even the sort
| of thing even worth thinking about going into suspended
| animaton for edit: on further consideration ,the situation is
| actauly reversed, our flora do survive us, but we will die
| without them, and they have other, rather gross means of
| survival, by ...raising the dead, literaly in the case of
| corpses in.the water, due to there continued activity, bloating
| a dead body wherapon they escape useing a balisic method, on
| decompression.
| shadowgovt wrote:
| The mutualism of microorganisms and humans is a fascinating
| and relatively new sphere of research. One such space is the
| family of antibacterial (and antiviral) viruses that have
| apparently evolved into a mutualistic relationship with
| humans: their development and proclivity _is_ tied to their
| hosts (they spread by direct placental diffusion from mother-
| to-fetus, or by milk, they 're too fragile to survive in the
| external environment, and since humans eating humans is rare
| they don't have other avenues) and so they actually have
| features that attack harmful bacteria, attack and disrupt
| harmful viruses, or generate immune-system antagonistic
| chemical signals to attract our defenses to incoming
| infections.
|
| They flew under the radar all this time because they're
| viruses; in general, the only viruses we're aware of in
| humans are the ones that cause harmful symptoms because
| actually visualizing the little bastards requires busting out
| the ol' electron microscope, so if they don't give us a
| reason to look we aren't looking!
| jgalt212 wrote:
| Here's a primer on the brain - gut connection. It's well
| established, but maybe not well understood.
|
| https://www.hopkinsmedicine.org/health/wellness-and-preventi...
| shadowgovt wrote:
| There has, apparently, been some research on this, but
| (IANADoctor) it doesn't look conclusive.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC6330042/ did mouse
| trials of fluoxetine and then checked the gut microbiome; they
| did find some changes in groups known to correlate with
| regulation of body mass. But, this is (a) mouse models and (b)
| a long string of correlations with (to my knowledge) no actual
| causal understanding.
| world2vec wrote:
| Some wikipedia context for this SSRI: "Fluoxetine, sold under the
| brand name Prozac, among others, is an antidepressant medication
| of the selective serotonin reuptake inhibitor class used for the
| treatment of major depressive disorder, anxiety, obsessive-
| compulsive disorder, panic disorder, premenstrual dysphoric
| disorder, and bulimia nervosa."
| westurner wrote:
| Fluoxetine also appears to increase plasticity in the adult
| visual cortex, which can reduce monocular dominance.
| https://www.google.com/search?q=fluoxetine+plasticity+visual...
| gradientsrneat wrote:
| Yep! And also psychosis (although generally not as the sole
| treatment).
|
| Regarding premenstrual dysphoric disorder, a common treatment
| is to take birth control alongside an SSRI. Coincidentally, the
| current US federal government wants to ban both of those.
|
| We still don't really know how most brain meds treat mental
| health issues, but most brain meds have far-reaching effects
| from the brain to the vascular system. So, a certain single
| medication may be used to treat both a mental health issue and
| a blood pressure issue.
| jfengel wrote:
| I've been taking fluoxetine for several years and haven't died of
| sepsis. So that's one more data point in its favor.
| saretup wrote:
| Now let's hear from some dead people for balance.
| fny wrote:
| Much salt: "fluoxetine _pretreatment_ " "in a mouse model of
| sepsis."
|
| I'd be interested to see how this holds up in EHR data with the
| caveat that anyone with mental health issues likely has a million
| confounders.
|
| I'm not even sure how this would be implemented in practice: at
| what point would patients be given SSRIs?
| criddell wrote:
| Are there any signals that a person may be in danger of
| developing sepsis? If so, wouldn't that be the time to consider
| prescribing fluoxetine?
| readthenotes1 wrote:
| Apparently 15% of cases start in hospital so that would be
| one signal
|
| https://www.verywellhealth.com/sepsis-while-
| hospitalized-858...
| Pxtl wrote:
| There's probably a whole cocktail of meds that should be
| administered when somebody is admitted, considering that
| hospitals are kind of inherently dangerous and people who
| are admitted are there because they're in a vulnerable
| state.
|
| ... well, the other thing that comes to mind like that is
| staph infections, but I guess preemptively giving everybody
| antibiotics to prevent that would be a good way to breed
| superbugs.
| cogman10 wrote:
| Yeah, seems like an easyish study to do. "Does EHR data show
| that patients on Prozac have a lower mortality rate from sepsis
| than the general population."
|
| > I'm not even sure how this would be implemented in practice:
| at what point would patients be given SSRIs?
|
| Perhaps right before and after a surgery when infection is
| possible?
| BobbyJo wrote:
| Fluoxetine has an insanely long half life, and your brain is
| sensitive to its affects. Not really a viable option for
| acute treatment.
| cogman10 wrote:
| > Fluoxetine has an insanely long half life
|
| The half life is 7 days.
|
| > your brain is sensitive to its affects.
|
| It takes time for SSRIs to take effect. Acute usage is
| probably ideal as you wouldn't be dealing with withdraw
| symptoms.
| yosito wrote:
| In other words, "Study in mice suggests that taking Prozac
| _might_ make you less vulnerable to sepsis. Further study needed.
| "
| jasongill wrote:
| This article is timely - I just returned home yesterday from the
| funeral of a very close friend who died of sepsis. He was told at
| the ER that he just needed to go home and rest and that his
| stomach pain was likely a colitis flare-up.
|
| I wonder if there will ever be a "rescue treatment" for sepsis
| that is based on this research. Lets hope so.
| winocm wrote:
| My condolences.
|
| I had SIRS/sepsis once and it really is a harrowing experience.
| It really changed me forever and as a bonus, if not to add
| insult to injury, my hair now falls out and barely grows.
| Wouldn't wish it on my worst enemy.
| igor47 wrote:
| I'm sorry. The same thing happened to a very close friend of
| mine. Sepsis is a bitch, and also I miss my friend all the
| time. I hope you have a community to support you in grief.
| balderdash wrote:
| This company https://cytovale.com/ has developed a diagnostic
| tool for sepsis, while not a cure it hopefully would make cases
| like your friend's less likely
| jmort wrote:
| Also https://inflammatix.com/
| zeagle wrote:
| A lot of drugs and efforts to treat sepsis/SIRS with
| inflammation have fizzled in trial. Tocilizumab, JAK
| inhibitors, and particaularly dexamethasone with its low NNT in
| COVID were interesting ones and suggest there is something to
| it but a complicated issue.
| Pxtl wrote:
| Its horrifying how many stories sound like that, like the
| recent story woman who got parasitic worms from Hawaiian food
| that crept upwards from her legs gradually causing pain until
| they made it to her brain and only then the cognitive
| impairment made doctors take her seriously. She kept getting
| sent home too.
|
| It's infuriating how many problems in our lives are met with a
| shrug.
|
| edit: I'm a jerk, I forgot we were talking about somebody close
| to you. I'm sorry about your friend and I hope you're doing
| okay.
| JumpCrisscross wrote:
| > _It 's infuriating how many problems in our lives are met
| with a shrug_
|
| If you know anyone in medicine you know they are swamped by
| hypochondriacs, frauds and crazies. Absent clear diagnostic
| criteria--or a person privately funding the search costs,
| with time and money--it's infeasible to expect a
| collectively-funded system to explore every potential case
| like an episode of _House MD_.
| throaway89 wrote:
| This is pretty hand-wavy. I was diagnosed with a rare
| disorder. My doctors said surgery was the only option and
| that it would be fine after. As it turns out, there's a
| radiation therapy that is 80% successful, been practiced
| around the world for 20 years with no serious side effects
| (including cancer), AND is practiced regularly by a RO here
| where I live.
|
| I had to find out about him by myself because my doctors
| didn't do anything other than look up my condition and give
| me the most common treatment option. In my case surgery
| usually makes things worse and is NOT advised other than as
| a last resort. My doctors didn't know any of this, because
| they didn't do their research.
| cma wrote:
| Or could be they knew the surgeon and send them business
| medimikka wrote:
| Rescue treatments are symptomatic. Which makes a lot of sense,
| if you consider what (medically) constitutes "sepsis."
|
| Any ED resident on their first week on the job should know how
| to diagnose sepsis: Temp >38degC (100.4degF) or <36degC
| (96.8degF), Heart rate >90, Respiratory rate >20 or PaCO2 <32
| mm Hg, WBC >12,000/mm3, <4,000/mm3, or >10% bands, Infection
| (suspected or present).
|
| Double down on the blood work, take liquor, empirically give
| antibiotics (less and less useful, given resistances), drop
| temperature (paracetamol), add fluids (drops heart rate, ups
| blood pressure), wait for labs.
|
| It's not hard, and I am so very sorry someone with sepsis signs
| was sent home. Sepsis is also a fast bastard. Meaning, from
| pathogen entering the blood stream to organ damage and
| conclusively death can be less than half an hour. That's the
| ones we can't catch. The guy with the ulcer, the person who
| injects things, the girl who didn't see a dentist about her
| developing abscess, the man who stopped his HIV meds... that's
| the ones I didn't in the past three weeks. I got them too late,
| or didn't see them until the ambulance unloaded a dead person.
|
| Sepsis is a bitch. A total and utter bad player, something we
| drill into every resident from day one. Sometimes Mrs.
| Goodforall comes in with a light chest tightness and leaves on
| a hearse, sometimes Mr. Bluebird presents with nausea and
| crashes into a full on septic shock minutes later. Any one of
| those I can prevent, I will. I am, however, not God. Just a ED
| jockey with an infectious disease background. I'm probably the
| best hope my patients have, which isn't much, but it's
| something.
| Madmallard wrote:
| What about the research surrounding high dose vit C,
| thiamine, dexamethasone or whatever that concoction was?
| jasongill wrote:
| Thank you; yes, he had a clinical history of colitis and
| other stomach issues, and had visited the ER due to abdominal
| pain over a weekend. On Tuesday he collapsed at home and was
| gone. I don't know what transpired with the doctor (and
| didn't want to pry too much with the grieving family) but it
| sounds like it was just missed or his symptoms misunderstood.
| I heard grumblings that the doctor was at fault but I don't
| fault them - things just happen and while it is sad, it just
| happens.
| shadowgovt wrote:
| If I understand correctly, this is one of those laws-of-
| exponents things that humans tend to have bad intuition for,
| right?
|
| Bacteria growth, unchecked, is exponential. The only reason
| we stay a coherent organism at all in this crazy world of
| trillions of other organisms is that our immune system checks
| the _hell_ out of bacteria growth.
|
| ... but when that 's no longer possible, when the body goes
| from being a hostile growth environment to food...
| enterococcus faecalis has a doubling time of 18 minutes. One
| such cell, with completely-unchecked reproduction, would
| produce a number of itself to rival the cell-count of the
| entire body in only 10 hours, and it takes _way_ less than 30
| trillion enterococcus to kill a person.
| FollowingTheDao wrote:
| This is great because I am a huge believer that the immune system
| is at the core of many, if not all, mood disorders and maybe they
| will start looking at immunoneurology to start finally curing
| mood disorders. For example, we know that stress effects the
| immune system by lowering T Cells, and we know that stress makes
| people depressed, so would it not follow that lower T Cells makes
| people depressed? (T Cells make IL10)
|
| Prozac makes me manic in a heart beat, literally one 10mg tablet
| (I have Bipolar Disorder) and they find higher levels of IL-10 in
| people with Bipolar.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC10357918/
|
| And IL-10 increases serotonin activity as well:
|
| https://pubmed.ncbi.nlm.nih.gov/23410504/
|
| So we should assume that lower IL10 could be a metabolic marker
| for depression.
| kerkeslager wrote:
| > This is great because I am a huge believer that the immune
| system is at the core of many, if not all, mood disorders and
| maybe they will start looking at immunoneurology to start
| finally curing mood disorders.
|
| Christ, please stop talking about science if your approach is
| going to be "I'm a huge believer in this hypothesis so any
| research which supports that hypothesis is great". We don't
| need more lunacy in science discourse.
|
| "The immune system is at the core of _some_ mood disorders " is
| a reasonable hypothesis which is quite possibly true, given
| what we know. It certainly warrants more research, but I
| haven't seen anything conclusive enough to justify being "a
| huge believer".
|
| "The immune system is at the core of _all_ mood disorders " is
| an actually bad hypothesis which untestable.
|
| > For example, we know that stress effects the immune system by
| lowering T Cells, and we know that stress makes people
| depressed, so would it not follow that lower T Cells makes
| people depressed? (T Cells make IL10)
|
| No, that does not follow. You're literally describing an A ->
| B, A -> C situation, which does not imply that B -> C. This is
| very, very basic causality reasoning you're screwing up here.
|
| Less confidence/arrogance/belief and more "maybe" and
| "possibly" would do you well here.
| FollowingTheDao wrote:
| What do I mean by "I am a huge believer that the immune
| system is at the core of many, if not all, mood disorders"?
|
| It means i think this is the direction research should take.
|
| It means if people have mood disorders they should see an
| immunologist first, becasue this is how we can find out right
| now if it is true. (Many people with Lupus do not know they
| had Lupus and they were institutionalized with
| neuropsychiatric lupus and never got the help they needed. My
| mother was one of them. And see:
| https://www.youtube.com/watch?v=SXFX6OnSlng
|
| That is the suffering those of us with immune issues have to
| put up with.
|
| Does it mean I just want science to prove my belief correct?
| Of course not. What you need to do is stop being so overly
| dramatic. What I do believe is more and more research is
| pointing to Neuroimmunology as the basis for most mental
| illnesses. Which means I am excited.
|
| https://pmc.ncbi.nlm.nih.gov/articles/PMC6693968/
|
| https://onlinelibrary.wiley.com/doi/abs/10.1111/cen3.12639
|
| > No, that does not follow. You're literally describing an A
| -> B, A -> C situation, which does not imply that B -> C.
|
| Of course, yes, correlation is not causation until it is
| proven. But absence of evidence is not evidence of absence.
|
| For eff sake, I was just excited and not I had to waste my
| time explaining this to you and you ruined everything.
|
| But let me tell you a story. Both times I caught COVID I had
| the worst psychosis of my life. And when I a sick with
| anything, there goes my mood as well. So if that does not
| tell you the immune system effects mental illness, what will?
|
| I mean, to me it seems stupid that people would disagree that
| the immune system causes mood changes. Who feels happy when
| they have the flu? And if you knew anything about the
| tryptophan -> Kynurenine/serotonin pathway you would be even
| more excited about this discovery.
|
| https://www.researchgate.net/figure/The-kynurenine-
| pathway-T...
|
| If you do not get excited, what kind of scientists are you?
| The most boring and uncreative kind I would say.
| passive wrote:
| My kid just went on this for anxierty a few weeks ago, happy to
| hear to has some side benefits.
| goda90 wrote:
| I wonder if this effect can also contribute to new allergies. My
| dog is on fluoxetine for anxiety. She also started having
| intermittent issues with hot spots and ear infections at some
| point after we started the fluoxetine. We have her on apoquel for
| allergies now, which is a steroid that impacts the immune system
| so she's getting double whammy impacts.
| AStonesThrow wrote:
| have you considered dialysis and chemotherapy, or space tourism
| myrloc wrote:
| I was just put on 6 weeks of antibiotics (ampicillin and
| ceftriaxone) for sepsis.
|
| I thought I was coming down with an annual bug (so did the docs).
| 3 days after going into an urgent care where I was told I was
| negative for flu and covid, I went to the ER, where they drew
| blood. All 4 blood cultures returned positive for enterococcus
| faecalis.
|
| The bacteria is very common in the intestines, but it's not clear
| (and probably never will be) how it made it into my bloodstream.
| Their best guess is inflammation in my gut allowing it to "leak"
| into the blood. This is after CT and ultrasounds of the abdomen.
|
| 29 years of no sepsis then.. random sepsis diagnosis!
| zeagle wrote:
| Glad you are OK. I am not your internist (/IANAL disclaimer)
| and I usually don't comment in HN medical threads as weird
| opinions here, but reading HN taking a break from my work, I'll
| say generally unless you have some reason like a recent dental
| procedure to have gotten it depending on your age I'd ask to
| get a (non urgent) colonoscopy or at least MR enterography or
| at least consideration of it with a reason why not with someone
| who knows the particulars of your case and can give you real
| medical advice.
|
| CT has limited ability to pick up GI malignancy that can lead
| to translocation of bacteria from colon. If you had something
| like an autoimmune colitis that lead to translocation you would
| need to get treated and not all have preceding symptoms.
| Spooky23 wrote:
| Thank you for saying this! A loved down was "in the clear"
| for some stuff. Unfortunately not so clear.
| Herodotus38 wrote:
| I am also not your internist but wanted to upvote and second
| this comment. Op mentions being 29 years old, but should have
| a gi tract evaluation. Not necessarily now when dealing with
| the bacteremia but should be discussed.
| myrloc wrote:
| Great ideas, I will ask about these in the follow-up with
| infection disease.
| Aurornis wrote:
| > but it's not clear (and probably never will be) how it made
| it into my bloodstream.
|
| The term for this is "bacterial translocation". The intestinal
| barrier isn't perfect and some level of bacterial translocation
| from the GI tract to the bloodstream isn't abnormal by itself.
| However, some combination of increased intestinal permeability,
| reduced immune defense, overgrowth of the bacteria in the GI
| tract, or mutations of the bacteria can lead to systemic
| infection.
|
| They probably gave you the "inflammation" explanation because
| it's more satisfying than "it happens some times and the
| potential causes are diverse".
|
| Glad you're doing better.
| Mistletoe wrote:
| The more worrying thing should probably be that prozac may
| increase your IL-10 levels all the time. The average person
| doesn't encounter sepsis that often in the modern world. You
| don't necessarily want IL-10 boosted all the time.
|
| https://www.sciencedirect.com/science/article/abs/pii/S13596...
|
| "The role of interleukin-10 in autoimmune disease: systemic lupus
| erythematosus (SLE) and multiple sclerosis (MS)"
|
| But the study is a single study in mice, etc. maybe the effect
| isn't even real.
| ekianjo wrote:
| for those who don't know, Fluoxetine is the generic name of
| Prozac.
| dimal wrote:
| Interesting, if this is holds up. I'm not smart enough to
| understand the mechanism. But it makes me wonder, what's the
| point of designing drugs? SSRIs were developed on the faulty
| theory that depression was caused by low serotonin and that
| increasing serotonin in the brain would cure depression. It
| didn't. In some percentage of people it attenuates it at varying
| levels, but even when it does work, it's not by increasing
| serotonin levels in the brain. It's clear that there's some other
| mechanism at work.
|
| It seems like many "wonder drug" discoveries turn out like this.
| A drug is created for disorder A. A lot of people take it. People
| start noticing other unexpected effects for disorders B-Z.
|
| So why bother designing drugs? We already have a huge cache of
| approved drugs where the safety profile is known. We could look
| at drugs with good safety profiles and see what else they might
| be good for just by luck.
| AStonesThrow wrote:
| yay
|
| I'm coming to suspect that the stuff used to formulate sodas, and
| other things regulated as foods, are nearly indistinguishable
| from Schedule IV/V and for all intensive porpoises, they comprise
| a Schedule VI of "let them eat cakes and drink ale".
|
| Eventually there will be a Red Bull Prozac Edition and Caffeine
| will be smuggled over international borders: Mark My Words!!
| petercooper wrote:
| Not to do with sepsis, but in case it interests anyone, I read
| some papers a few years ago about how very low doses of
| fluoxetine (below the dose where it works as an SSRI, with all
| the side effects that confers) can stimulate the production of
| neurosteroids which in turn can reduce neuroinflammation, reduce
| anxiety, and various other things (Google "low dose fluoxetine
| neurosteroids" to find several).
|
| I had chronic low-level anxiety for a few years so decided to try
| it and after a couple of months I realized it had all gone away.
| I take 5mg 2/3 times a week (clinical dose for depression is
| 20mg/day and up) and have had no negative side effects. My doctor
| knows and while they're not up on the mechanics of it, they said
| if it's working, keep going.
| medimikka wrote:
| When I went into residency, my attending once described any drug
| acting on reuptake (be it antagonistically, agonistic, or in a
| bifurcated model) as the medical equivalency of noticing your car
| is low on oil and, in response, pouring a few dozen liters of the
| stuff over the engine block.
|
| Some gets to where it needs to be, the rest gunks up the engine
| on the outside and in places it shouldn't be.
|
| Almost any drug acting on 5HT (fk acts on 2C), acts on other
| receptors as well. Fk acts on a1, M1-4, and many more, it's not
| very selective. A venerable bucket of oil, indeed. This is, what
| also causes Long-QT, feeding disorders, diarrhea, shorter
| pregnancies, dry mouth, sexual dysfunction, and more.
|
| Sure, dropping such a bucket of oil can also, via inflammatory
| pathways, elicit IL-10 activation and, more importantly, act
| against hypertriglyceridemia. But that should not be sold as a
| solution to a problem. Again, to stay with contrived comparisons,
| if I load the boot of a car with C4, I am sure that some parts of
| the car will reach more than the car's stated maximum speed. But
| that's not a desirabe outcome.
|
| As a last ditch, I'd consider it. But "preventatively" as
| suggested... that's a far, far, reach.
| cj wrote:
| After reading your comment, I was wondering "why do this study
| in the first place" if researchers are just pouring oil on an
| engine.
|
| The last sentence basically says that it's too difficult to get
| new drugs approved, so instead let's try to find new benefits
| of already widespread drugs. I suppose it's better to pour oil
| on an engine than to have no oil at all.
|
| > One of the most cost-effective and quickest strategies to
| develop treatment strategies is repurposing already approved
| drugs for new conditions. Our study provides sufficient
| rationale to further explore the therapeutic uses of SSRIs
| during infection and to reveal new and exciting immunometabolic
| targets during sepsis.
| rjurney wrote:
| His comment isn't a medical opinion. It's a sarcastic
| anecdote.
| rjurney wrote:
| Sorry, what does this have to do with the study? Obviously
| reuptake inhibitors save many lives and you're acting like
| they're all unusable. As a doctor, isn't this irresponsible?
| H8crilA wrote:
| He says that a) yes there are many receptors which will be
| triggered by the same drug at the same time, so it can have a
| variety of effects, b) it's possibly not worth it to take it
| as a preventive measure. That doesn't mean he says it
| shouldn't be taken to cure or at least manage debilitating
| disorders like depression. Cost vs benefit.
|
| The discussion of costs/risks of treatments is usually what's
| missing in the casual conversations about drugs. Ketamine or
| psylocybin are probably the best examples in the tech
| community, yes they can sometimes cure a depression, or at
| least suppress it for a while, but they can also cause
| psychosis (and other non-psychiatric symptoms), so they are
| used only after safer options fail.
|
| Although I'm not sure I get the concern here, sepsis is very
| life threatening, so paying SNRI-level risk for prevention
| doesn't seem like an outright bad idea. Unless the idea would
| be for random people to start using this drug just in case
| they get stabbed and go septic - then I would say this is not
| a good idea. But I don't think this is what the paper
| describes.
| forgetfreeman wrote:
| That wasn't my takeaway at all. As someone who's been on the
| receiving end of various SSRIs for big chunks of my adult
| life their analogy seems pretty on-brand compared to the
| experience of taking SSRIs. They fuck with so many things
| that aren't the problem at hand it beggars belief. Anyway, if
| anything my takeaway was confirmation of my suspicion that
| SSRIs are the polar opposite of targeted therapeutics.
| philjohn wrote:
| And many other people tolerate them absolutely fine,
| without a ridiculous number of side effects.
|
| Both of us are sharing anecodtes, however.
| spoonfeeder006 wrote:
| They never said not to use Fk for major depression or other
| life threatening psych issues
| Lerc wrote:
| I think the analogy would work better if you had a couple of
| iron filings with the design of the engine block imprinted on
| it, then you constructed the engine by pouring buckets of stuff
| in the right proportions at the right time until the iron
| filings formed a working engine.
|
| If such an engine existed, perhaps it might be more amenable to
| refilling its oil in such circumstances.
| herniatedeel wrote:
| I get that fluoxetine, a relatively old SSRI is a dirty drug,
| but aren't newer serotonin modulators _much_ cleaner? E.g.,
| vilazodone, vortioxetine, and even old-fashioned Escitalopram
| (lexapro)?
|
| My understanding is that escitalopram has pretty low binding
| affinity for other receptors than SERT.
| anjel wrote:
| It takes 3-6 weeks to exert its effect on mood, so how long does
| it take to act upon IL-10?
| AnthonBerg wrote:
| Haphazard guess: 2-3 days, and based on 5-HT2A receptor
| activation and/or Sigma-1 receptor activation rather than
| serotonin reuptake inhibition.
| willy_k wrote:
| My question is why is time and money being spend on researching
| this, as opposed to something like its long term effects on the
| brain or what happens when it's use stopped. Sure this finding is
| a fun thing that might be lumped into a psychiatrist's spiel, but
| is there _any_ utility for this research?
|
| I certainly hope that someone at risk for sepsis wouldn't be
| prescribed an antidepressant to treat it, or that someone already
| on it wouldn't be prescribed an antibiotic anyway. Even as an
| adjunct for sepsis I would be highly skeptical of its
| practicality. Perhaps the research may provide insights into
| mechanisms that future drugs may be designed to exploit, but even
| that seems like a stretch as a justification.
| wk_end wrote:
| > as opposed to something like its long term effects on the
| brain or what happens when it's use stopped.
|
| There is no "as opposed". The people studying that sort of
| thing - and people do study that sort of thing - aren't the
| same people who are studying sepsis.
|
| > Perhaps the research may provide insights into mechanisms
| that future drugs may be designed to exploit, but even that
| seems like a stretch as a justification.
|
| Why does that seem like a stretch? A better understanding of
| how the body works and/or responds to/metabolizes various drugs
| can absolutely guide drug discovery.
| volkl48 wrote:
| Sepsis is one of the leading causes of death and causes ~20% of
| all global deaths.
|
| Research into quite literally anything that might give
| additional help to treating it is so obviously one of the most
| beneficial things we could be doing in terms of medical
| research that reading your post sounds completely foreign to
| me.
|
| -------
|
| Many cases of sepsis are relatively predictable in that they
| already know that this person is at high risk of it due to
| their condition or the type of intervention that's going to be
| required for their condition.
|
| We're just not that great at stopping it from occurring with
| the tools currently available - antibiotics are not sufficient
| to solve/prevent it like you seem to think they are, or there'd
| be a lot less people dying of it.
|
| -----
|
| Presumably, if this research panned out in many additional
| trials, it's something that might be added to treatment
| protocols.
|
| Even if it turned out to be useful but had limitations like
| being needed to be administered days in advance - there would
| still be significant utility for a lot of medically necessary
| but not immediate high-risk surgeries.
| hanklazard wrote:
| I am absolutely floored by the depth of this paper. They really
| explored so much of the phenomenon and were able to dissect much
| of the mechanism.
|
| This is also such a fascinating example of the body's
| inflammatory response to a pathogen being one of the major
| drivers of mortality. I suspect we'll find this to be the case in
| many more disease processes in the future.
| rjurney wrote:
| This is beautiful. So many boomers have severe chronic pain and
| depression... get them on Prozac and address these issues while
| protecting them from Covid-19 related complications.
| buildsjets wrote:
| It's too bad that the position of the United States Secretary of
| Health and Human Services is that only drug addicts use
| Fluoxetine and that it should be banned.
| shadowgovt wrote:
| Interesting!
|
| Given this pathway, and given that "Selective serotonin reuptake
| inhibitors (SSRIs) are some of the most prescribed drugs in the
| world," we should be seeing inverse correlation between increases
| in prescription of fluoxetine and heart disease (outside of
| larger novel or growing factors _causing_ heart disease, of
| course).
|
| I wonder what the research looks like in that space...
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