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Patients have been telling me for years that there's a problem with their medications when they are switched to generics. I've heard this when I worked in psychiatric hospitals and in private practice and, sometimes, on the board. In the hospitals, unfortunately, the patients were often dismissed as being difficult because the physicians believed there was absolutely no difference between the two formulations of the medications.

Unfortunately, many healthcare providers have seen this as an indication of something akin to the placebo effect seen in clinical trials. In other words, they weren't believed.

Well, now mental health professionals are beginning to talk about it openly and do some research in the literature. What it has turned up should be of interest to anyone who has been having problems with their anxiolytic or antidepressant medications.

The journal Clinical Therapy in both 2003 and 2004 noted that there is a difference between brand and generic medications. The journal Hospital Practice also looked at the differences between generics and brand benzodiazepines. The differences can, according to psychiatrists I've heard from, be as much as 20-30% in the bioavailability of the medication.

Simply put. this translates into the percent of a medication that can be absorbed and utilized. Some psychiatrists have noted that they've had to increase the dose of a generic as much as 50% to get the same effect they would get with the brand name.

So, if your med doesn't appear to be giving you the same effect and you've been changed from a brand, perhaps you and your doc might want to research this literature further. I did a quick search on PubMed and found 18 citations talking about this problem. The areas of concern were in transplants, birth control, psychotropics and seizures.

The literature indicates that some medications may dissolve slower and not provide the necessary medication into the blood while others (meds for seizure disorder) resulted in breakthrough seizures. Remember, not all the medications found in this preliminary search were for anxiety or depression, but they provide some needed insights into how medications may differ.

As always, be an informed consumer of any product or service and ask whatever questions you need to in order to come to an informed decision. Caveat emptor is always a good thing.

 

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