17 U.S. Code § 107 - Limitations on exclusive rights: Fair use
Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work, including such use by reproduction in copies or phonorecords or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright. In determining whether the use made of a work in any particular case is a fair use the factors to be considered shall include—
(1) the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes [all mirrored content falls under this clause, any ads present are mirrored from the original site, mirrored content earns me no revenue whatsoever];
(2) the nature of the copyrighted work [this is a unique resource for the mentally ill, and preservation of it can be argued to be incredibly important];
(3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and
(4) the effect of the use upon the potential market for or value of the copyrighted work. [absolutely none whatsoever, as the original work no longer exists anywhere else (outside of whatever bits and pieces archive.org managed to capture) - the original site was intermittantly completely unavailable for a extended period of time before its SSL certificate expired (and was never renewed), and eventually the site went offline for good, then finally the DNS records were removed at some point prior to May 2018, so at this point it is well beyond the 'dead and rotting' stage]
The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.

This domain is not controlled by Jerod Poore, and I will NOT continue redirecting traffic from this domain to crazymeds.us [as I formerly did] while Jerod continues with his immature temper tantrum over adblock or continues to fail to maintain his site, fucking over his entire community and countless visitors in the process. [belated clarification: with specific regards to the adblock drama I was referring to Poore at one point replacing his entire site with a single page complaining about the amount of revenue lost to users with ad blocking active, which is something that I took extreme exception to because this affected ALL visitors to the site regardless of if or if not they were actually using ad blocking]
This mirror is unfortunately incomplete (and very slightly outdated), as /CrazyTalk/ was not included when I scraped the site (it was far too large to scrape given the site's extremely poor performance, my wish to avoid worsening the poor performance further, and other factors). If you're looking for a replacement forum, I suggest visiting https://www.crazyboards.org/forums/. There are issues with many of the mirrored pages, I am working on identifying and fixing them, but I do not have the time to address every single issue at this moment (although by now the majority of these issues have been resolved). Dynamic content is obviously completely broken (this is beyond my control), and the loss of /CrazyTalk/ is quite bad given how much good user-generated info was on there, but you have Jerod to "thank" for that. Maybe I'll bring it back online at some point, but it wouldn't be the same as before. For now, I suggest visiting CrazyBoards instead.
Note (Oct 9 2018): Infrequent additional updates regarding the status of this site will be posted on https://info.crazymeds.net

how long until MultiPageMedicationArticle starts to work, likelihood MultiPageMedicationArticle will work for your condition, and MultiPageMedicationArticle vs. other Misc

> How Long Until Multi Page Medication Article Works

Approved & Off-label Uses | MultiPageMedicationArticle Index | How to Take and Discontinue MultiPageMedicationArticle
Return to the MultiPageMedicationArticle Page

Comparatively Effective

Two of the most important things to know when deciding on which med is the best for a particular condition1: how likely is it to work and how long will it take.

The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Aside from it being hard enough to get an accurate diagnosis when brain cooties are involved, why is it so difficult to figure out if MultiPageMedicationArticle (longmed) is right for you and how long it will take for you to know that?

  • Because no one is quite sure exactly what causes various conditions.
  • Which is further complicated when everything is a spectrum disorder (e.g. bipolar 1, bipolar 2, all the others they still ignored in DSM-5).
  • And they’re never really sure about how MultiPageMedicationArticle works in the first place.
  • Plus, if you have more than one condition for which you’re taking one or more medications to treat, things get really complicated.
  • None of which is helped by studies that produce contradictory results and other quirks in The Literature.

Always remember: if your symptoms suddenly get a lot worse, call your doctor immediately. Any drug that makes your symptoms worse is a drug you probably need to stop taking as soon as possible.

We reference a shitload of studies here, so you might want to see our pages on how to deal if a study is legitimate and the tests and methodologies researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.

How Long Until MultiPageMedicationArticle (longmed) Starts Working

Isn’t this one of the most important question your doctor or pharmacist should be able to answer? Yes, it is. Did you remember to ask them that?

Efficacy Source Material

Here’s where I get the data to base my odds on how long it takes for, and how well a drug will work:

  • Clinical trials and other studies published in The Literature.
  • Consumer reviews.
  • Experiences reported on sites about meds, conditions, or sites that have nothing to do with either, but have a strong demographic overlap.
  • While I write a lot about any personal experience I’ve had with a med, I rarely include that in my calculations on how well a med will work. I know what freaks Mouse and I are.

All the books I read about meds aren’t particularly helpful about actual odds. They work at a much higher level, helping me categorize meds into first-, second-, and third-line treatments. A “third-line treatment” not only means that it is less likely to work, but it may not work as well. Not all third-line (or lower) treatments are off-label. Many of them are just old. Phenobarbital is approved to treat epilepsy and reserpine is still approved as an antipsychotic. The former is 90% likely to control any seizures in high enough dosages, you just wouldn’t be able to do much of anything besides sleep. The latter is an OK AP, not the best in the world and with some unusual side effects for an AP. It’s main advantage is being available as a plant extract in south and southeast Asia.

Lexapro for MDD & Anxiety

A good page to look at for this is Lexapro’s:

You should still give it at least three weeks, unless the side effects hit hard, fast, and don’t start getting better within two weeks of reducing the dosage (if there’s any room to reduce the dosage).

How Effective MultiPageMedicationArticle (longmed) is for its Approved Uses

Back in 2004 Crazymeds has been the only site crazy enough to give you some idea of how likely it is a med will work for you. Sure, it’s filled with enough CYA weasel wording to make a Big Pharma lawyer proud, but at least I try to give you a reference point.

If there are enough of them I’ll add sub-headings, to make it easier to find specific conditions.

Once again, let’s look at some of Lexapro for MDD, as it has a shitload of great data to back this up.

Major Depressive Disorder (MDD)

The odds are pretty good that Lexapro will work for MDD, as in you have a 60–75% chance that you’ll respond to Lexapro2 - i.e. it will do something positive - and a 60–70% chance of remission, i.e. your MDD symptoms will more-or-less go away and stay away, although you may have to keep taking your meds to ensure you stay symptom-free.
Keep in mind that:

  1. Serotonin reuptake inhibition, and everything else SSRIs do, is not the answer for everyone, either by itself or at all.
  2. When you pool all the data together (see below) you’ll find that Celexa and Lexapro are better than the other SSRIs. It’s marginally statistically significant for everyone who still takes the other SSRIs. Their real advantage comes from sucking less than the others and being better at preventing relapses, so if you and your doctor think you’re going to be depressed forever without meds, you’re way better off with Celexa or Lexapro than another SSRI or other antidepressant.
  3. We can’t hammer this point home as hard or often enough: antidepressants work only for people who are seriously depressed.3

Like most SSRIs the clinical trials published in the PI sheet used a ridiculously small set of people with vague results. How small? The usually don’t print the number of patients, that’s how small. Things are different in Canada, where some actual numbers are published in the PI sheet. But it tells us only that people felt somewhat better, and not how many of them did.

Unlike most antidepressants I was actually able to find the clinical trials on PubMed, although there are no more data in the abstracts than in the PI sheet. Except for Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. The discrepancies between the PI sheet and the abstract that are really telling. The US PI sheet, which doesn’t allow you to copy any text, has the typically vague result of “statistically significant greater mean improvement compared to placebo on the MADRS.” But when you look at the study:

Clinical response was evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS), the 24-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) scales, the Hamilton Rating Scale for Anxiety (HAM-A), and patient-rated quality-of-life scales.
RESULTS: Escitalopram, at both doses, produced significant improvement at study endpoint relative to placebo on all measures of depression; significant separation of escitalopram from placebo was observed within I[sic] week of double-blind treatment. Citalopram treatment also significantly improved depressive symptomatology compared with placebo; however, escitalopram, 10 mg/day, was at least as effective as citalopram, 40 mg/day, at endpoint. Anxiety symptoms and quality of life were also significantly improved by escitalopram compared with placebo. The incidence of discontinuations due to adverse events for the escitalopram 10 mg/day group was not different from the placebo group (4.2% vs. 2.5%; p = .50), and not different for the escitalopram 20 mg/day group and the citalopram 40 mg/day group (10.4% vs. 8.8%; p = .83). Cipralex Canadian Product Monograph

Predicting if a med will work for you is something that can be really useful.

Likelihood MultiPageMedicationArticle (longmed) will Work for Off-Label Applications

Off-label uses are pretty much the same as approved ones, except there won’t be anything in the PI and usually fewer clinical trials and longitudinal studies.

I think we’ll stick with Lexapro. Unlike drug companies, I’ll tell you if another med is better.

Panic-Anxiety Disorders other than GAD

Except for hoarding, where you’ll want Paxil, Lexapro may as well be approved for the rest of them. Oh, wait, Lexapro is approved to treat other anxiety disorders, just not in the US. We really need a way to streamline the approval process for meds when they’re already available here and approved for something else in practically every other country on the planet. In any event…


MultiPageMedicationArticle (longmed) versus Other Misc for its Approved Indications

Comparing meds head-to-head can be a lot of fun. For me, but I don’t have a life. Many of the papers here will be meta-analyses and reviews, and while I don’t rate those very highly, few only some of them are worse than nothing.

This time around Lexapro is especially instructive for examples of not only contradictory data, but contradictory interpretations of the same data about the one question we are repeatedly asked that no one bothers to read the page on:

Lexapro vs. Celexa

Lexapro vs. Celexa. This is one of the most asked questions we get when it comes to comparing meds, and it should be. Is there a real difference in efficacy between Lexapro and Celexa?

  • Sort of, but not by much.
  • Even though Lexapro works faster the real difference is in the long run, because Lexapro sucks a little less. So more people will take Lexapro for a longer time, but the difference is such that it matters only to individuals and national healthcare systems, and not HMOs and insurance companies. Which is why generic citalopram is covered while still-expensive escitalopram isn’t.
  • Is it worth switching from Celexa to Lexapro? If you’re thinking about it then it’s worth talking to your doctor about it, but it’s probably not worth arguing with either whoever prescribes it or pays for it.
  • But if you haven’t started on either, and Lexapro is an option that won’t cost much more than Celexa, go for the Lexapro.
  • Let’s see what the science says:
    • Cipralex vs. Cipramil in outpatients with depression. A Lundbeck-sponsored trial. 20mg of Cipralex/Lexapro vs. 40mg of Cipramil/Celexa. The results: Lexapro worked better (76% response rate, 61% remission rate vs. 56% and 43% for Celexa), and while both didn’t suck all that much, Lexapro sucked even less (4 out of 138 quit taking Lexapro due to side effects vs. 9 out of 142 for Celexa).
    • Cipralex vs. Cipramil for depression treated by primary care physicians. Another Lundbeck-sponsored trial. 10mg of Cipralex/Lexapro vs. 20mg of Cipramil/Celexa. The results: A little odd. At the end of 8 weeks Lexapro had a 63% response rate and 55% remission rate vs. Celexa’s 55% and 45%, by week 24 Lexapro had an 80% response rate and 76% remission rate vs. Celexa’s 78% and 71%. The odd part is both meds were way more effective for the moderately depressed than the severely depressed at week 8, and Lexapro was barely more effective for the moderately depressed at week 24. This runs counter to all the studies showing meds to be more effective for the severely depressed. But there are always studies with atypical results.
    • Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Britain’s NHS undertook this study. The results: Lexapro “dominates” Celexa and Effexor. That’s what they wrote. Lexapro “just dominates” Effexor.
    • Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Just like the above study, only in Spain. They also use the term “dominant.” Otherwise Lexapro had a higher remission rate than Celexa and Effexor (58% vs. 38% vs. 32%), otherwise there wasn’t much difference between Lexapro and Celexa. Both were better than Effexor.
    • escitalopram vs. citalopram vs. sertraline for Unipolar Major Depression. 10–20mg of Lexapro vs. 20–40mg of Celexa vs. 50–150mg of Zoloft. The results: holy shit! 97% response rate for Zoloft vs. 90% for Lexapro vs. 86% for Celexa!?! Oh, wait, the trial was sponsored by Torrent pharmaceuticals. The real winners were the researchers. I’m taking this one with a shaker of salt.
    • Lexapro vs. Celexa - which is worse to overdose on? This is actually an interesting question, as only critters have been given more than 60mg of Lexapro. Does the two-to-one dosage ratio of Celexa to Lexapro hold up when you take an entire bottle? How much difference does the r-enantiomer of Celexa make? The results: Celexa is more toxic than Lexapro, but, like all SSRIs, it’s next to impossible to kill yourself with them. Although the median dosage of Celexa was higher (310mg vs. 130mg for Lexapro. The equivalent dosage of Celexa would be 260mg.), it’s hard to tell by how much that skewed the results. The most striking was the incidence of seizures, 30 for Celexa vs. 1 for Lexapro.
    • Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. This analysis of Lundbeck’s clinical trials, and some of the studies and trials listed above, calls statistical shenanigans. Their main concerns: Over-reliance on the bullshit MADRS - see the page on psych tests for more info - and disputing claims of statistical significance. I’ll leave the latter up to people with better stat chops than I have. As this is the full text and the full text is available for several of the referenced papers, you can compare them all yourself.
    • Escitalopram: superior to citalopram or a chiral chimera? This analysis also calls statistical bullshit on Lundbeck’s claims that Lexapro is superior to Celexa.
    • This analysis looked at the same data and thought it all looked good.

You’d think that would answer the question, huh? I’ve got more on Lexapro vs. other meds for both MDD and GAD. You can look at the Lexapro Efficacy page for them.

How MultiPageMedicationArticle (longmed) Compares with Other Drugs for Off-Label Treatments

In most of the studies, etc. med the one the page is about - like Zoloft, for a change - is not the med the study is necessarily about (i.e. the drug owned by the drug company who sponsored the study). The cage matches - studies involving four or more meds - are supposed to be completely objective4.


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This is new for the multi-page format. Currently the bibliography is on its own page. I’m changing that for various reasons. Until it’s filled you’re going to see " $BigBiblio " all over the place.
On the a lot of the more detailed pages the bibliography will mainly consist of the articles linked to above. Yes, redundant as hell. There’s a reason for it. When possible I want it to be easy you to see for yourself how I back up what I’ve written. But in the article portion of a page there will be code to optimize searches for indications, side effects, and other medication-related article-specific crap. Citing also has standards. I can’t do both in the same place. So formal citing needs to be here. The citing part is still a work in process, but it’s has to start somewhere.

Approved & Off-label Uses | MultiPageMedicationArticle Index | How to Take and Discontinue MultiPageMedicationArticle

1 Assuming you were correctly diagnosed in the first place.

2 The data are often contradictory when compared with Celexa. Celexa averages 60-70% for both response and remission, while Lexapro is often in the neighborhood of 70-75%; hence the big spread on the response rate that seems a bit low given the results of a lot of studies, trials, and anecdotal evidence.

3 Most of the time at any rate. There's always an outlier study or two, as you'll see if you keep reading this page.

4 Like Fox News and murder investigations in Texas and the Deep South are supposed to be completely objective.

If you have any questions not answered here, please see the Crazymeds MultiPageMedicationArticle discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)

Last modified on Saturday, 15 November, 2014 at 15:23:37 by JerodPoorePage Author Date created
“MultiPageMedicationArticle (longmed): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2014 Jerod Poore Published online 2014/05/29
Citation options to copy & paste into your article:
Plain text:Poore, Jerod. “MultiPageMedicationArticle (longmed): a Review for the Educated Consumer.” Crazymeds (crazymeds.net). (2014 ).
with Microdata: <span itemprop='citation'>Poore, Jerod. "MultiPageMedicationArticle (longmed)." <em>Crazymeds (crazymeds.net)</em>.(2014 ).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://crazymeds.net/pmwiki/pmwiki.php/Meds/HowLongUntilMultiPageMedicationArticleWorks'>"MultiPageMedicationArticle (longmed): a Review for the Educated Consumer."</a>. <a href="https://crazymeds.net/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.net)</em></a>. (2014 ).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://crazymeds.net/pmwiki/pmwiki.php/Meds/HowLongUntilMultiPageMedicationArticleWorks'>"MultiPageMedicationArticle (longmed): a Review for the Educated Consumer."</a>. <a href="https://crazymeds.net/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.net)</em></a>. (2014 ).</span>

MultiPageMedicationArticle, and all other drug names on this page and used throughout the site, are a trademark of someone else. MultiPageMedicationArticle’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.

Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
Keep up with Crazymeds and and/or my slow descent into irreparable madness boring life. Pick your preferred social media target(s):

Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 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 something along the lines of following disclaimer, I’m usually cool with it.

All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or 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. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still 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 medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you 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. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore

1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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