How to Read the Crazy Meds' Drug Pages

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How To Read My Drug Information Pages

You should take a moment to learn how to read this information. Some of it is pretty obvious, but some of it isn't.

Just as the drug companies don't have a single format for their PI Sheets, we don't yet have a single format for the drug pages. That's the wonderful thing about standards, there are so many of them from which to choose.

Here is my new & improved format for side effects information. Eventually all meds will be converted to look like this. Many of the meds still have most of this information on one page. This multi-page format is my current goal.

Here's what the effects, comparisons with other meds & ratings page for a med will look like:

Odds of a Med Working: This will be for approved uses and popular off-label uses. I don't give casino or track odds (i.e. 5-2 it will work for something). It's something a bit more vague. Good, pretty good, excellent, not that good. Stuff like that. As to how I arrived at the above odds, mostly it's from anecdotal evidence gathered from various online support groups I monitor, user ratings and comments at Remedy Find, experiences people send to me via e-mail and summaries of efficacy from the books in the references on the page. Those will be the usual suspects at this time: Dr. Stephen Stahl's Essential Psychopharmacology: The Prescriber's Guide, Dr. Diamond's Instant Psychopharmacology, Dr. Drummond's The Complete Guide to Psychiatric Drugs , Preston et al.'s Consumer's Guide To Psychiatric Drugs, Mitzi Waltz's Partial Seizure Disorders, Dr. Amen's Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD and Dr. Devinsky's Epilepsy: Patient & Family Guide. Additionally there are the trials and studies from the the PI Sheet / PDR, Mosby's 2004 Drug Guide and trials I found through Pub Med.

How It Compares to Other Meds: I've been noticing lots of studies about how one med compares to another. This is something you'll rarely find in a PI Sheet. Keep in mind who sponsors the study, as it will tends to make the results more favorable for the med in question, on average 3.6 times more likely, according to a Yale study. When I can I'll include the sponsor of a study. These will all be studies with links you can go to.

If you're really interested, this article explains how the drug companies are able to fudge the numbers in their favor for the studies.

If I find enough studies for particular conditions then I may have multiple pages for odds and/or comparisons to other meds. It all depends on what I find.

I'll also try to explain some of the scales used to measure how well drugs works in the above to sections. Here are some that I've found out about already:

Brief Psychiatric Rating Scale (BPRS), a multi-item inventory of general psychopathology traditionally used to evaluate the effects of drug treatment in schizophrenia. The BPRS psychosis cluster (conceptual disorganization, hallucinatory behavior, suspiciousness, and unusual thought content) is considered a particularly useful subset for assessing actively psychotic schizophrenic patients. It's like the MMPI of crazy.
Clinical Global Impression (CGI), reflects the impression of a skilled observer, fully familiar with the manifestations of schizophrenia, although it is vague enough to apply to any form crazy, about the overall clinical state of the patient. In other words, how loony your doctor thinks you are.
The Positive and Negative Syndrome Scale (PANSS) a 30-item rating instrument evaluating the presence/absence and severity of positive, negative and general psychopathology of schizophrenia. The scale was developed from the BPRS and includes other symptoms, such as aggression, thought disturbance, and depression. This is a much more accurate test, if standardized tests are your thing, of insanity. The version I have, from a hospital in Zurich, has two additional questions at the end. In their own category. In German. I guess they're for people channeling the ghost of Albert Speer or something like that.
Scale for the Assessment of Negative Symptoms (SANS). This is a relatively new test looking at an axis of five "negative" symptoms: affect flattening (i.e. you talk like I do), alogia (Periods of speechlessness, in other words you still talk, or not talk, like I don't. Get the picture?), avolition-apathy (i.e. not giving a shit before you were put on antipsychotics), anhedonia-asociality (Nothing is pleasurable, you don't like people, i.e. you're a natural born goth.) and attentional impairment (Huh? What did you say?). If this is the scale of negative symptoms what the fuck is the corresponding "positive" assessment? Oh, hallucinations, delusions, formal thought disorder, and bizarre or disorganized behavior. Many of us in the Asperger's part of the autistic spectrum would be given a 72-hour time-out automatically after one of these tests. Hell, many of the people across the autistic spectrum would get such a time-out from polite society based on the fine-tuned sensitivity, and lack of specificity of this test.
Young Mania Rating Scale . Whoopee shit. You score 0-60 on all of 11 items assessing irritability, disruptive/aggressive behavior, sleep, elevated mood, speech, increased activity, sexual interest, language/thought disorder, thought content, appearance, and insight. Basically if you didn't have the bipolar diagnosis already the test would be fairly pointless in trying to figure out if you bipolar, schizophrenic, obsessive-compulsive, schizoaffective or even ADHD. Even some people in particular parts of the autistic spectrum who aren't bipolar would score well on it. Try taking it during a bout of severe depression, you may not have any self-esteem, sexual interest or least of all elevated mood and activity, but everything else could be really out of whack and you could get hit with a bipolar 2 diagnosis even if you aren't really bipolar 2.

Hell, in the short term under the right conditions a freaking placebo can quell the manic symptoms as rated by the YMRS. That's why longer trials and better metrics are required. In the short run, all sorts of non-med approaches will actually work to bring someone down from a manic high for a day or a week. (By the way, these are great emergency tactics if a benzodiazepine is unavailable or inappropriate.) That's why Bach Flower Remedies or that Serenity crap appear to work in the short term. And why the miracle drug Placebo will sometimes beat a med in one of its short-duration trials when only the YMRS is used. It's part of the reason why so many of us fall into the trap of thinking we can deal with our illness without meds, or with dangerously bogus "treatments." But in the long term failure to deal with mania leads to kindling, and that will lead to a mental meltdown that will put you in the lock ward of the psych hospital. If you're lucky.

The Hamilton Rating Scale For Depression (HAM-D) - 21 questions where your doctor determines how much your life sucks.
Beck Depression Inventory (BDI) - Another 21 questions where you give your opinion on how much your life sucks. Or you've been listening to too much Beck. One or the other.
The Montgomery-Asberg Depression Rating Scale (MADRS) - For doctors too busy to ask the 21 questions on the HAM-D. No shit. It's popular with drug companies because MADRS scores improve regardless of the antidepressant used.
The Manic State Rating Scale (MSRS) - 26 behaviors, scored on frequency and intensity. Covers dysphoric and euphoric manias. There's less cross-over with ADD/ADHD than the YMRS and as someone who has lived long-term manias and has been around plenty of people in dysphoric and euphoric manias, this is a much better indicator of mania. Does OK as far as standardized go in covering mixed states. But, really, if a doctor is going to being giving you a test for bipolar, this is the one to take as far as the manic phase goes.
For all other scales which might be used in various studies that I haven't put up here or created links to, you might find them at either Neurotransmitter.net's treasure trove of psychiatric rating scales or Psychiatric University Hospital Zurich's page of Rating Instruments and Questionnaires (with both English and German questionnaires). Just don't go downloading a bunch of these to self-diagnose. That's just wasting your doctor's time because you probably have a bad case of cyberchondria.

Remedy Find Rating This is the link to the great Remedy Find site for a particular medication and application for that med. There you will find a Consumers Report style rating for the med, based upon the reports of actual users. Each drug is rated for effectiveness, side effects, ease of use, long-term effectiveness and cost. As it's one of those 1-10 style ratings you really do need at least 20 people rating something for it to be meaningful. But even with fewer than 20 people, it's always worth it to check out the stories to read about how different people react to the same medication. Now you understand why the mantra for psychiatric medications is, "Your mileage may vary." Add to the knowledge base by registering and adding your own ratings. The newsletters Brett produces are worth it.

You'll see by a drug's off-label use that it may be prescribed for a variety of disorders. I'll include just a couple for Remedy Find. If you don't see a link for a Remedy Find rating, that doesn't necessarily mean there isn't one, the odds are just that I was too lazy at the time to include it! The Remedy Find site is easy enough to navigate. If there's not a link for why you take this drug, just click on what I have and see if the disorder is listed at Remedy Find. If so, you'll find practically every med ever tried for it.

Consumers Report is just now beginning to rate a limited number of psychiatric meds. There was great media hoopla when they announced that. Brett has been providing a place for actual consumers to rate meds for five years now. As usual mainstream media has dropped the ball.

The Crazy Meds' Navigator Panel for anticonvulsant pages

Here are the links to other pages about a med:

Basic Information Page Side Effects Page Dosage, Discontinuation and Half-Life Page Effectiveness, Comparison with Other Meds and Ratings Pages How it Works in Your Brain Page Buying, Pricing & PI Sheets Page Special effects & Issues page Comments

Check for Drug-Drug Interactions This is the link to another great site, just to check drug-drug interactions. I use this site because they include drug-food interactions and interactions with non-prescription medications. They also differentiate between sustained release and immediate release version of meds. It's the most comprehensive drug interaction site I've seen. Don't freak out over the AIDS thing. Yes, it's owned and operated by HIV+ people. So what? It's not like you're going to get HIV through your computer. Practically every freaking drug on the planet is in their database, that's all that matters. No matter what sort of wacky combination of drugs you take, if a drug-drug interaction has been published, it finds its way into their database. Eventually. Hey, nobody's perfect. If you want omniscience, take it up with some deity or another. Because of the HIV issue, they cover food interactions, and that's something too many doctors and pharmacists won't even think of. Maybe the grapefruit thing will come up, but there's a lot more than that. Anticonvulsants, commonly known as "mood stabilizers," are especially sensitive to what types of foods you eat or if you take your meds with food or not.

This is where I beg you for money to help support the site. And, basically, me:

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The Overlords of the 12 Zernox Galaxies have compelled me through messages in the Sunday Chronicle to beg you for funds to help squash the Arachnoid uprising. So if this site has been of use and/or amusement to you, we'd be grateful if you could donate some cash.

Visit the Support Page for how you can help if you don't have any money laying around. This includes reviewing Crazy Meds for Amazon.com and/or

There's also our Mental Mall, to purchase some books or t-shirts.

Here's a section to help navigate the site, in case you're still living in the 1990s and don't have frames activated. Or just stumble across a page via a search engine:

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Crazy Meds Home Crazy Meds Talk About Antidepressants About SSRIs About Anticonvulsants / Mood Stabilizers About Atypical Antipsychotics About Benzodiazepines About Stimulants Finding a Doctor Sites with More Information Support Group Sites About Crazy Meds Crazy Meds: The Blog

Check for Drug-Drug Interactions

Here's some news about the med or other relevant subject:

Psychiatric Drugs in the News

Anti-Epileptic Drugs in the News

Take care of yourself, and keep taking your crazy meds!

Jerod

If you still have unanswered questions about this or other medications, including which one is, or combination of meds are the best for you, your best bet is to ask on Crazy Meds Talk. Better yet, if you want to let the world know how they worked out for you and want to help out others in their quest for the correct meds, join the party.
If you want to discuss your issues, I suggest checking out one of the various support groups online.
Otherwise, if you're letting me know about how much you like or hate the site, or need to let me know about medication effects in private, then just drop a note to jerod23 at gmail dot com Honestly, I usually don't have a lot of time to answer e-mail these days. The snide autoresponse message that may or may not hit your mailbox is going to tell you the same thing.
Another problem is that you may not get a response even if I wanted to send you one. You see, so many dickweeds with malicious intents and too much time on their hands have appropriated the crazymeds.org domain name to use for their spam, viruses and the like. Subsequently some lazy-ass e-mail protection software authors just go by the domain name, and not the IP address. So I've been blacklisted because of the actions of others. Or the software just doesn't like the domain name because of the "crazy" and/or "meds." Or your question about a particular medication will set off spam flags. So the e-mail just wouldn't go through regardless. Sorry.

Hey, did you find this page all by itself through Google or some other search engine? Great! But to really appreciate the entire site, you need to start here.

Dead tree references:

Here is where I list the books I've referenced in writing about a med with handy click-to-buy buttons. Although I'm moving to listing books I referenced directly in the article in the place where I used them as source material, most of the pages have the books here.

End of books used for this article.

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Here are timestamps showing you when a page was created and last updated. It's good to know these things when validating a site for trustworthiness.

Created Monday, April 04, 2005

Last updated Monday, May 24, 2010

Here's the copyright information and bigass disclaimer:

Almost all of the material on this site is copyright Â© 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009 and 2010 Jerod Poore. Except, of course, the PI sheets, those are the property of the drug companies who developed the drugs the sheets are about. And any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That's usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that's OK to just do. Go for it! Please. As long as you include this copyright notice and the following disclaimer, I'm cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.

"Everything is true, nothing is permitted." - Jerod Poore