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Dietary/nutritional supplements, complementary and alternative treatments, and meds: another morass of misinformation, controversy, and outright holy wars1. Many people will take various cocktails of herbs, vitamins, minerals, and anything else that falls under the category of dietary/nutritional supplements along with their meds, or even instead of medication because they are afraid of the dangerous, yet extremely rare, side effects of medications. So, in fairness to the meds…
1. It’s Natural, Man.
Note the name of this site. Crazy Meds. The only thing classified as a nutritional/dietary supplement you can buy in the US without a prescription2 that has been more-or-less proven3 to do anything in the way of brain cooties - specifically unipolar and bipolar depression - is the EPA component of Omega-3 fish oils. The prescription version of concentrated EPA, Lovaza, is approved to treat the high triglycerides associated with heart problems and diabetes. The amount of EPA it contains - 465mg, along with 375mg of DHA - is a bit awkward for many people to use it to treat depression, as one capsule may not be enough but two would be too much, and too high a dosage can render EPA ineffective. Even one capsule might be too much, as the effective dosage to treat depression is usually 300–800mg a day. So you’re probably better off getting the non-prescription supplement, and that’s pretty much the only supplement we currently consider an actual treatment for any mental illness and/or neurological condition.
If you want to get information on using St. John’s wort, 5-HTp/tryptophan, or anything else you can buy from Ye Olde Vittamin Shoppe, to treat a condition, you’ll have to go elsewhere. I do have some advice for you:
- Anything that may work (and even stuff that doesn’t) will have side effects. E.g. St. John’s wort causing photosensitivity and the failure of hormonal birth control, and that people have died from taking fish oil. (Go ahead, look it up on the PI sheet.) Anything that claims to have no side effects, interactions, etc. is either lying to you or is an expensive placebo.
- Anything that may work (and even stuff that doesn’t) may have interactions with any medication, prescription or OTC, and other supplements you take. More on that below.
- In the US regulation of supplements barely exists, so what is promised on the label is often not the same as what is actually in the bottle. Although it’s usually peppermint or other innocuous substance instead of a prescription medication that, you know, works.
- Most books touting so-called ‘natural cures’ for various conditions are more about making money for the authors and publishers than they are concerned about your health and well-being. The authors and publishers aren’t much different than board members of pharmaceutical companies (AKA Big Pharma).
- Your doctor may be the world’s biggest jerk, but do you honestly think the patchouli-drenched clerk in the Whole Foods supplements department knows more about treating full-on bipolar disorder or epilepsy?
- “Natural” does not always mean “safe.” More on that below.
- Get a second opinion about any supplement from the National Institutes of Health Office of Dietary Supplements.
2. Yeah, But Don’t We Need to Replace all the Stuff the Meds Suck Out of Us?
I’m aware of only two essential nutrients that are proven to be directly affected by crazy meds:
Folic acid/folate/vitamin B9. If you take an anticonvulsant/antiepilepctic drug (AED) (which are also a class of mood stabilizers), you need to take a folic acid supplement. It’s just a given.
- While it’s difficult to take enough folate all at once for it to be toxic, too much folic acid can interfere with the effectiveness of AEDs.
- Because being folic acid antagonists (drugs that inhibit the synthesis of folic into various substances useful in cellular reproduction) may or may not be part of how some AEDs work.
- The data are really mixed on this. Really mixed.
- Most of the stuff about too much folic acid lowering your seizure threshold, and the extent of folic acid-AED interaction dates back awhile.
- The meds you have to be especially concerned about are mostly older ones:
- So stick to somewhere between the USRDA minimum (400mcg) and 800mcg, just below the upper limit (1,000mcg).
- Because taking too much, regardless of what crazy meds you take, might increase your risk for cancer. Which makes total sense, since folate is all about cellular reproduction.
Vitamin D3. Like folic acid, it’s only if you’re taking an AED, and it’s a little more complicated, because too much vitamin D can cause problems. You mainly have to worry about it if you take an enzyme-inducing AED such as:
- Dilantin (phenytoin) and phenobarbital4 are the worst offenders, so if you take those your doctor may not even bother with a blood test and just tell you to take some vit. D.
- You may have to take a vitamin D supplement if you take Lamictal (lamotrigine), as the data aren’t clear regarding Lamictal.
- As to how much to take, that’s something you need to work out with a doctor, as it will take a couple of blood tests to determine if you need to take the USRDA of 600iu, or a lot more to compensate for one or more of the medications encouraging your liver to metabolize it a lot faster than normal.
- Plus the enzyme-inducing AEDs are the worst when it comes to making you photosensitive, which makes it even harder to get your daily vitamin D!
- However, since vitamin D isn’t water soluble, it’s less difficult to build up a toxic amount than it is with folic acid, in the range of 10,000 to 40,000 IU a day if you’re not taking any of the AEDs listed above. That’s something you can easily accomplish with a regular purchase from a supplement store.
2.1 If Only it were that Simple
It’s difficult to tell if there’s a direct link between calcium and AEDs, as vitamin D is essential in how well your body utilizes calcium. The connection between long-term use of AEDs and bone density problems has been known since forever. But are the meds affecting the bones directly, or messing with calcium metabolism similar to vitamin D, or is it vitamin D to calcium to bone density? Damned if I know. Should you be taking calcium supplements? Again: ask your doctor and get a blood test for this one, and only if you’re taking one of the meds listed above5. You may also require a calcium supplement, and then it gets into all sorts of multiple vitamin and trace mineral combinations that are way beyond what I’ve looked into. And calcium can interfere with how well you absorb Neurontin (gabapentin), so you may have that to consider as well.
3. Mother Earth, We May Have a Problem
People also look into using supplements to deal with side effects. This is where things really go sideways.
- Supplement-drug interactions, especially herb-drug interactions, cause a shitload of problems.
- The example I use all the time is Ginkgo biloba + epilepsy + AEDs = dead.
- While it’s probably an outlier, this review, along with the review above on supplement-drug interactions, mentions a case where ginkgo + trazodone = coma.
- Vitamin E, not just useless as a supplement, but potentially harmful. Take enough of it and it can also render some meds useless.
- Since the meds are ‘toxic’ in some way, you need to detox, right? This guy ‘detoxed’ his way back into severe depression.
- The vast majority of meds discussed on this site (and all meds in general) are metabolized/cleared/eliminated by one or more of the following enzymes: CYP2C9, CYP2C19, CYP2D6, CYP3A4, and UGT1A. St. John’s wort and panax ginseng speed up the clearance of a buttload of medications. Ginseng can also slow down the elimination of a lot of meds, as will garlic extract and kava. Valerian and milk thistle will slow the metabolism of a few, most notably Lamictal (lamotrigine).
- Fortunately the drug-drug interaction checker we use, and many others, do supplement-drug interactions as well.
- As I wrote on the side effects page, use extreme caution with any supplement containing selenium. Frequently used to deal with hair loss - a symptom of actual selenium deficiency - an early sign of selenium overdose is: hair loss.
- I so love the irony of this one: Case of acute psychosis from herbal supplements. She wasn’t taking a bunch of different weight-loss and “sports nutrition” supplements to offset side effects, because she she had no history of psychiatric problems and wasn’t taking any crazy meds, but she needed a cocktail of Risperdal, Haldol, and lorazepam to to deal with the psychotic episode the supplements caused!
4. No Matter What, Avoid These like the Plague
- Kava (Piper methysticum). Banned or restricted all over the world because it can make your liver implode. There may be a way to process it in a way that is far less toxic, such as how Pacific Islanders have been doing since forever. And they still don’t use it every day.
- Gingko biloba. While it might have a future as a source of something, the powdered leaves and tinctures you usually find are useless and have so many herb-drug and herb-herb interactions that it will mess with almost anything you’re taking.
- Cascara sagrada. It’s “slimming” and used to “detoxify” you system as well as treat constipation. A lot of the preparations contain California buckthorn (Rhamnus purshianus), which is pretty freaking toxic. I guess after taking this you’ll be really thin after puking and shitting your guts out, so they aren’t lying about the constipation part. As for its detoxification properties, that must apply to after going to the hospital to deal with this poison.
- Pennyroyal oil (Mentha pulegium). People take this internally? Seriously? Anyone who does should be filtered out of the gene pool.
- Traditional patent medicines. I used to take this crap, and I wouldn’t be surprised if it contributed to making my various health problems worse.
- Granted, the reports of mercury poisoning are somewhat dated.
- But lead poisoning is still popular.
- Even articles positioning traditional medicine in the same class as ‘Western’ medicine make it seem like quackery.
- I’m sure there’s some sort of culture difference getting lost in translation, but do you really want to take anything that uses ingredients like toad venom, arsenic and mercury for applications such as “Clearing wind phlegm” and “Depriving the evil wetness”? I am not making this up!
- And that’s from an article that shows how traditional Chinese medication is on par with Western (allopathic) medicine.
5. One More Thing
Finally, if you wound up preventing a med from working as it should, or otherwise screwed yourself with supplements, don’t beat yourself up over it, that’s our job. Anyone can mess themselves up with supplements, including me and members of the Special Forces.6
We have a topic on the forum about meds and supplements.
There’s also one on drug-food-herb-etc. interactions.
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1 Holy war: An intense, never-ending argument that spans newsgroups, fora, bulletin boards, mailing lists, etc., where no one's opinion will ever change. E.g. abortion, gun control, Mac vs. P.C., old Star Trek vs. subsequent Star Trek series.2 Yes, there are such things as prescription-strength nutritional supplements like vitamins and minerals, and even prescription foods.
3 The data are still too mixed on St. John's wort, so go ahead and treat mild-to-moderate conditions with it instead of meds if you want to.
4 Phenobarbital is still a second-line, and even first-line AED in many parts of the world. Places where money, crappy infrastructure, and stigma make it difficult enough for people to take the phenobarbital, let alone another pill on top of it.
5 Or anything else that is a CYP3A4 inducer. If "CYP3A4 inducer" doesn't mean anything to you, don't worry, just type it into teh googles and you'll get a bunch of relatively complete lists. Read enough of this site and you'll learn what it means along with all the crazy meds that induce, inhibit, or suppress various enzymes. Don't forget: supplements and even foods can mess with you. Too much beta carotene, garlic or vitamin E can cause you to lose vitamin D. Drinking grapefruit juice and taking megadosages of vitamin D every day (it doesn't have to be at the same time) and you need only 5,000 to 20,000 IU a day to reach a toxic level of vit. D.
6 I'm pretty sure they won't have to kill us now that I've told you about it.
Page created by: Jerod Poore. Date created: 30 May 2011 Last edited by:
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, and 2012 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 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.
The information on Crazy Meds 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.
Know your sources!
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 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 through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. 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 patient information leaflet (PIL) that comes with your medications and never ever throw them away.
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 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.
All brand names of the drugs listed in this site are the trademarks of the companies named on the PI/SPC sheet associated with the medication, sometimes on the pages about the drugs, even though those companies may have been acquired by other companies who may or may not be listed in this site by the time you read this. Or the rights to the drug were sold to another company. And any or all of the companies involved may have changed their names.
Crazy Meds is optimized for the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Firefox or Safari, which is what a plurality of visitors use. And I’m running Windows XP3. 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, Crazy Meds 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 Crazy Meds is not responsible for whatever weird shit your browser does or does not do when you read this site2.
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 or in all dimensions of reality.
‘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 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?
[begin rant] I rent a dedicated server for Crazy Meds. It’s sitting on a rack somewhere in Southern California along with a bunch of other servers that other people have rented. The hardware is identical, but no two machines have exactly the same operating systems. I don’t even need to see what is on any of the others to know this. If somebody got their server at the exact same time, with the exact same features as I did, I’m confident that there would be noticeable differences in some aspects of the operating systems. So what does this mean? For one thing it means that no two computers in the same office of a single company have the same operating system, and the techs can spend hours figuring out what the fuck the problem could be based on that alone. It also means that application software like IP board that runs the forum here has to have so many fucking user-configurable bells and whistles that even when I read the manual I can’t find every setting, or every location that every flag needs to be set in order for a feature to run the way I want it to run. And in the real world it means you can get an MBA not only with an emphasis on resource planning, but with an emphasis on using SAP - a piece of software so complex there are now college programs on how to use it. You might think, “But don’t people learn how to use Photoshop or Adobe Illustrator in college?” Sure, in order to create stuff. And in a way you’re creating stuff with SAP. But do you get a Bachelor of Fine Arts degree with an emphasis on Photoshop?
Back in the Big Iron Age the operating systems were proprietary, and every computer that took up an entire room with a raised floor and HVAC system, and had less storage and processing power than an iPhone, had the same operating system as every other one, give or take a release level. But when a company bought application software like SAP, they also got the source code, which was usually documented and written in a way to make it easy to modify the hell out of it. Why? Because accounting principles may be the same the world over, and tax laws the same across each country and state, but no two companies have the same format for their reports, invoices, purchase orders and so forth. Standards existed and were universally ignored. If something went wrong it went wrong the same way for everyone, and was easy to track down. People didn’t need to take a college course to learn how to use a piece of software.
I’m not against the open source concept entirely. Back then all the programmers read the same magazines, so we all had the same homebrew utilities. We even had the forerunner to QR Code to scan the longer source code. Software vendors and computer manufacturers sponsored conventions so we could, among other things, swap recipes for such add-ons and utilities. While those things would make our lives easier, they had nothing to do with critical functions of the operating system. Unless badly implemented they would rarely cause key application software to crash and burn. Whereas today, with open source everything, who the hell knows what could be responsible some part of a system failing. [/end rant]
