Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Seroquel (quetiapine) Review


The Seroquel (quetiapine) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Seroquel (quetiapine) provides what the educated consumer wants, highlighting its use as, and comparing it with other {{$$drugclass2}}. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Seroquel (quetiapine), and consumer experiences.

Classification

Primary Drug Class

Seroquel (quetiapine) is in the Antipsychotics class of medications.

Additional Drug Categories

Antidepressants Anxiolytics/Anti-anxiety MoodStabilizers

Indications

A review of Seroquel’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

Immediate-Release Seroquel

Immediate-release Seroquel was originally approved in September 1997 to treat schizophrenia in adults. Since then its approvals have been expanded to include:

  • Treatment of schizophrenia in adolescents aged 13 to 17.
  • Acute depressive episodes in bipolar disorder.
  • Acute manic episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex, in adults as well as children and adolescents aged 10 to 17.
  • Maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex.

Extended-Release Seroquel

Seroquel XR is rated XR, in that it is for adults only. Otherwise its approvals are almost identical to vanilla1, immediate-release Seroquel:

  • Schizophrenia
  • Acute depressive episodes in bipolar disorder
  • Acute manic or mixed episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex.
  • Maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex.
  • Bonus approval: adjunctive therapy to antidepressants in major depressive disorder.

Drugs sometimes have different approvals in different countries.2 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

Clinically Significant or Otherwise Common Off-Label Uses

* Insomnia

Less Common/Experimental Off-Label Uses

Othello syndrome in patients with Parkinson’s disease. Othello syndrome is a freaky rare side effect of dopamine agonists used to treat Parkinson’s and RLS, such as Mirapex (pramipexole) and Requip (ropinirole). Such drugs are commonly used off-label to treat depression, especially bipolar depression.

Failed off-label uses

Potentially dangerous off-label uses

Seroquel for sleep apnea. This is actually a case report of two people with sleep apnea, one of whom wasn’t aware of it, were taking Seroquel for something else, and almost died. So it’s not fair to Seroquel to call it a side effect, but is a great warning to never, ever use Seroquel if you have sleep apnea or it is suspected.



Efficacy & Comparisons with Other

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

Unlike other antipsychotics, which can start getting your symptoms under control within 24 hours, Seroquel / Seroquel XR can take up to a week to work. It doesn’t matter what you’re taking Seroquel for, schizophrenia, bipolar mania, a mixed state, unipolar or bipolar depression, GAD, as an add-on or by itself, it’ll take 4–7 days before Seroquel does anything.

Unless you’re taking it for sleep. That first 25–50mg knocks out most people.

Efficacy for its Approved Indications

Pretty good for schizophrenia, so-so for bipolar mania, fairly good for bipolar depression, and as an add-on for MDD (XR only).
Stahl prefers it for bipolar depression and schizophrenia’s negative symptoms, although its sedating properties can be useful for aggression. He also likes Seroquel for psychiatric applications if someone also has Parkinson’s or Lewy body dementia.
Everyone else treats Seroquel as a second-line med for its approved applications, with the consensus being it’s the first one to try if the problem is depression/negative symptoms combined with insomnia.

Looking at some of the online literature in addition

Bipolar depression

For Off-Label Applications

Seroquel XR works so well when used by itself (monotherapy) for generalized anxiety disorder (GAD) the only reason the FDA didn’t approve it to treat GAD is because the side effects suck too much when compared with what is already on the market. Take a look at these randomized, double-blind studies:

Seroquel versus Other Antipsychotics for Approved Indications

For Off-Label Uses

Seroquel vs. Paxil for GAD: Seroquel works better and faster than Paxil. You can take Seroquel and be fat, horny, lazy, and maybe shaky, or take Paxil and wait for it to work, and never want or be able to have sex.

These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Seroquel (quetiapine) Should Be Recommended

  • You’re depressed as hell and can’t sleep. So if you’re going to gain weight no matter what, because lack of sleep can lead to obesity and even diabetes 2, you may as well take Seroquel.
  • You have GAD and SSRIs don’t do squat for you. Screw the FDA, you know which sucks less, and gaining 5–20 pounds sucks a lot less than GAD.
    • Especially if you’re so severely depressed and anxious that either one would prevent you from leaving the house.

Why/When Seroquel (quetiapine) Should Not Be Recommended

  • Sleep isn’t a problem for you and you gained five pounds as soon as your doctor gave you a prescription for Zyprexa.
  • Anxiety? What anxiety? You can sleep and you’re not anxious,
  • Or you’re bipolar goddammit and you need something to deal with that right now!
    • Which part of “right now!” is so difficult for your doctor to understand?
    • While 4–7 days to work is fast for anxiety and depression, that’s forever for mania and schizophrenia, and that’s how long it also takes Seroquel to do anything except knock you out at night.
  • You might have sleep apnea (see below).


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Dosage, Titration, and Discontinuation

A review of Seroquel’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

For bipolar: PI sheet: start at 100mg a day in two 50mg doses and increase by 100mg to 400mg day by day four. If needed, up it by 200mg a day until reaching 800mg a day by day six.
We suggest starting with one 25–50mg dose at night if you’re taking another mood stabilizers, or the 100mg a day in two 50mg doses if you aren’t. If you need to increase by 25–50mg a day every 3–4 days and stay at whatever dosage gets your symptoms under control. Unless you’re seriously flipping out, in which case follow the PI sheet’s guidelines until your symptoms are under control or you hit 800mg a day. For schizophrenia: PI sheet: start at 50mg a day, divided into two 25mg doses, but they still want to ramp you up to 300–400mg a day by day four.
We suggest starting with 50mg a day and, as with bipolar disorder, increasing by 25–50mg every 3–4 days until your symptoms are under control. If you’re crazy enough to be getting coded messages in your cereal, then get to 300–400mg by day four.

Dosing Schedule

Titration Schedule

One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

Your doctor should be recommending that you reduce your dosage by 25–50mg a day every other day if you need to discontinue it. You can stop taking all it immediately if it’s an emergency (e.g. a life-threatening allergic reaction), but I wouldn’t recommend doing that without a doctor’s supervision. The major problem with stopping antipsychotics is a sudden return of your symptoms.

Discontinuation Symptoms

Notes, Tips, etc. About Discontinuing Seroquel



Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Seroquel (quetiapine) for its approved indications and clinically-significant or otherwise common off-label uses.

Pros

As one of the mildest - and most prescribed - of all antipsychotics it doesn’t really carry the antipsychotic stigma as heavily as the other meds. Less likely to cause side effects involving prolactin (e.g. leaking nipples or man boobs) or movement disorders.

Cons

You’ll sleep until next Tuesday. Of course, that could be a good thing, depending on how your life is at this moment. Other than the sleep thing, it takes longer than any other atypical antipsychotic to work. You’ll probably gain weight and you might come down with type 2 diabetes.

When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

Seroquel is marginally better absorbed with food. So if you feel you need just a little boost in the dosage, try taking it with dinner or a late night snack.

Like most drugs older people don’t clear it out of their systems as well, too the point that they may need a lower dosage. That’s not particularly interesting. What is interesting is that Seroquel seems to work better for people under 40 than over 40.

What Seroquel (quetiapine) is Best Known for

Seroquel is notorious for two things - making you sleep until next Tuesday, and giving you a hangover when you eventually wake up.

Noted Traits & Effects



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Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

The usual short-term side effects for second-generation / atypical antipsychotics (SGA/AAP): headache, nausea, dry mouth, sleepiness or insomnia, diarrhea or constipation, not giving a damn about anything (a.k.a. the zombification effect). Most, if not all of these will go away in a couple of weeks. Except for the excessive sleepiness, which could hang around for as long as you take this med, but is usually not much of a problem once you’re taking more than 200mg a day.

And, of course, weight gain. Although it’s not as bad as Zyprexa.

Uncommon Adverse Events

Diabetes. Manic reaction. Muscle aches and pains. Getting all sweaty for no good reason. Tremor. Irregular heart beat and prolonged QT interval. While the sexual dysfunctions aren’t as bad as Risperdal (risperidone) or Zyprexa (olanzapine), they can still happen.

Potentially Dangerous Adverse Events

Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

Infanticide. Priapism (i.e. the never-ending hard-on) from an overdose. Kids, don’t try this at home as a Cialis substitute The PI sheet also lists “bone pain” and “abnormal ejaculation” so I’d be especially careful about taking too much to stay hard.

Ways to counter / minimize / mitigate / deal with some side effects

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Seroquel in these countries

* Seroquel XR/XL is available in Australia the EU, Ireland, New Zealand, and the UK
  • Immediate-release Seroquel is available in Australia the EU, Ireland, New Zealand, and the UK

Other trade name(s) for Seroquel used in these countries

Generic Name and Availability

US Generic name/INN:quetiapine
US Generic available?Yes

quetiapine is available in these countries3

  • Only the immediate-release version of Seroquel (quetiapine) is available as a generic in the US and Canada. Seroquel XR is still on-patent and available only as a branded product. According to some AstraZeneca press releases November 2016 is the current forecast date for a generic version of extended-release quetiapine to be available in the US.
  • Immediate-release quetiapine is also available in New Zealand

Branded Generic Names4 & Transcribed or Transliterated INN/Generic Name5

  • quetiapin - Hungarian


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Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

Generics with independently-tested bioequivalence

How Supplied

Available/Supplied As

Also available as Seroquel XR extended-release tablets

Shelf Life

3 years.

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Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Seroquel’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014

{{$$bigbiblio}}


1 Vanilla as the geek slang for plain. As far as I know, no one makes a vanilla-flavored quetiapine. Although that does seem like a good idea.

2 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

3 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

4 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

5 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.


If you have any questions not answered here, please see the Crazymeds Seroquel 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.us)


Last modified on Monday, 23 September, 2013 at 11:11:37 by JerodPoorePage Author Date created
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Seroquel, and all other drug names on this page and used throughout the site, are a trademark of someone else.

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.




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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, 2012, 2013, and 2014 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 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. 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 the browser you’re not using on the platform you wish you had. Between you and me, it all looks a lot cleaner using Safari or Chrome, although more than half of the visitors to this site use either Safari or Internet Explorer, so I’m doing my best to make things look nice for IE as well. I’m using Firefox and running 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 of anonymity. 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.

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