![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 44. Go back in thread:
Posted by bleauberry on November 16, 2008, at 11:28:07
In reply to Success Story-surprise result, posted by Neverquit on November 15, 2008, at 16:16:13
To me this is not a surprise result at all. I have a lot of tiretracks across my back from my negative critical view of generics, especially concerning prozac, xanax, lamictal, or wellbutrin. I take a lot of critisism from other people. Most people think it is hogwash. Most doctors are not aware. Research pinheads say the drugs are equivalent. Nobody considers, or when they do they don't admit, that fillers make a difference.
If fillers don't make a difference, then someone explain why original Nardil and new Nardil are so different. The only thing that has changed is the stuff the active ingredient is mixed with. And someone explain to me why dozens of people have relapsed when switched to generic even when they didn't know they had been switched. No placebo effect. And then they got better when switched back to brand.
Fillers can make a significant difference. For example, calcium carbonate can turn a fast release med into a semi-extended release med. That is going to affect how that med works, either positively or negatively, either way, it is different than brand. Fillers can cause unsuspected allergic responses, which set off chain reactions from the gut all the way to the immune system and nervous system that can overwhelm any good that the active ingredient is trying to do. Even the color dyes used in pills and capsules can cause problems, with FDA Red and Yellow being the most problematic. These things are especially true with anyone under stress or chronic illness, which pretty much means most of us here.
We humans, all of us, tend to think we are smarter than we actually are. I believe there is some unknown action of certain fillers in how the active ingredients are absorbed, at what point in the intestinal tract they are absorbed, how they bind to protein, how they enter the brain barrier, and who knows, all kinds of stuff we probably have never ever thought of. There is so much more than we know, and to assume all fillers are neutral is, well, human nature on display.
My own personal experience was what prompted me to keep an eye out for reports of generic vs brand comparisons. I was fine on prozac for several years but within about a month just unexplainably fell apart little by little. I was not even aware I had been switched to generic. When I returned to brand prozac, it felt like a completely different and much more robust drug. I can take a brand xanax or a generic and they feel like two totally different meds. One generic company does make a very good brand subsititute for xanax though.
I've said it before and I will keep at it. That is, when it comes to health and especially mental health, paying 5$ at the pharmacy versus paying $100 should make ZERO difference in the choice of medication. Why? Because the stakes are too high. Get the good stuff. If it works, try switching to the generic afterwards. If that works, awesome. If not, go back to brand.
For any of the generic vs brand experiences to be "all in someone's head" means there are hundreds or thousands of people who don't know each other, never talked to each other, live hundreds or thousands of miles away from each, yet experienced the exact same things.
Posted by Neverquit on November 16, 2008, at 11:46:28
In reply to Re: Success Story-surprise result, posted by bleauberry on November 16, 2008, at 11:28:07
> When I returned to brand prozac, it felt like a completely different and much more robust drug.
Though it is subjective, I completely agree with this. Prozac feels much "stronger".Something I thought was unusual, was that my P-doc mentioned that people can have transitional PSYCH reactions when switching to/from a generic brand/name brand.
This indicates to me that there is a difference in ACTIVE ingredients, not just "filler", or, at least, the way the "filler" is interacting with the active ingredients is causing a change in the net efficacy.
Posted by bleauberry on November 16, 2008, at 14:17:59
In reply to Re: Success Story-surprise result, posted by Neverquit on November 16, 2008, at 11:46:28
>
> This indicates to me that there is a difference in ACTIVE ingredients, not just "filler", or, at least, the way the "filler" is interacting with the active ingredients is causing a change in the net efficacy.Actually I tend to agree with that. As I know my posts on generic vs brand are already controversial, I was trying to keep it a little tamer by just looking at fillers. But yes, I do believe there is something different about the active ingredient as well. What? I don't know. I mean, salt is salt, diamonds are diamonds, regardless whether natural or manmade, right? What could be different?
At one time the entire world's experts believed earth was flat. At one time all experts believed ulcers were from stress. For the longest time they ridiculed the discoverer that ulcers were from a certain bacteria.
I've seen this saying prove itself true over and over, usually in places where we think we know it all, "the more we know, the more we realize we don't know".
I probably wouldn't give much thought to some phenomenon that pops up rarely. But with this particular topic, it pops up over and over all the time, usually by new people who are naive to it ever being a previous topic. So I have to give it merit, though I can't explain it. Numbers speak. And of course my own experiences were dramatic enough to take serious notice.
Posted by linkadge on November 16, 2008, at 14:42:58
In reply to Re: I noticed something with the name brand, too, posted by Neverquit on November 16, 2008, at 9:15:02
Oh, I fully believe there are others who think the same thing.
Some people think that KD is better than No Name Mac and Cheeze. That doesn't mean there is any merrit to it
Ok, bad example.
Linkadge
Posted by linkadge on November 16, 2008, at 14:54:19
In reply to Re: Success Story-surprise result, posted by bleauberry on November 16, 2008, at 11:28:07
>If fillers don't make a difference, then someone >explain why original Nardil and new Nardil are >so different.
Cause meds poops out and people want something to blame that on.
The only way I would believe such claims is if there was a double blind trial during which an individal could guess which version of the drug they were on.
People just get into a routine and they are pickey. Its the same thing with all sorts of medications.
Just ask a pharmacist! Seriously. They will tell you that all hell breaks loose when they try to change some peoples medications to the generic. And that is before they have even tried the medication!
I've been there when a pharmacist tired to change some old lady's blood pressure medication to a generic. The lady went on and on about how the color was different and the shape was different and how she didn't want somebody changing her medication etc. etc.
People get very particular about their psychiatric medications.
Linkadge
Posted by linkadge on November 16, 2008, at 14:58:22
In reply to Re: Success Story-surprise result, posted by Neverquit on November 16, 2008, at 11:46:28
>Something I thought was unusual, was that my P->doc mentioned that people can have transitional >PSYCH reactions when switching to/from a generic >brand/name brand.
>This indicates to me that there is a difference >in ACTIVE ingredients, not just "filler", or, at >least, the way the "filler" is interacting with >the active ingredients is causing a change in >the net efficacy.
Not necessarily. Again, placebos have real psychiatric effects. Many people refuse to believe that they were infact taking placebos in clinical trials (after this informaiton is disclosed to them).
A perceived difference can easily translate to real psychological effects.
Linkadge
Posted by linkadge on November 16, 2008, at 15:02:50
In reply to Re: Success Story-surprise result » Neverquit, posted by bleauberry on November 16, 2008, at 14:17:59
I give up.
But like I said, as long as it works for you - who cares.
You'll know in a few months if what you are proposing is true.
Linkadge
Posted by SLS on November 16, 2008, at 16:23:35
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 14:42:58
I guess you don't have to take anyone's word for it, but I have witnessed a friend of mine relapse into depression upon a change from Wellbutrin to the generic bupropion. She was able to recapture the antidepressant response only after she restarted the name brand. She had been stable on Wellbutrin for many years. This was not a case of transient spontaneous poop-out.
My doctor has seen differences in generics too. I particularly remember a case that involved Paxil and the generic paroxetine. His patient was stable for about a year on Paxil before relapsing upon the change to paroxetine. Again, the therapeutic response was captured once Paxil was reintroduced.
The FDA does not require that a drug company produce double-blind studies to determine the efficacy of a generic drug candidate, even with the described differences in the "inactive" ingredients between preparations. The FDA simply relies on the work done previously by the original name-brand drug manufacturer.
I am taking a generic lamotrigine, but my doctor was insistent that the pharmacy dispense the product of a specific manufacturer. He has noted that there are differences in efficacy among generics of the same compound.
Different is different. I, for one, don't feel so confident that generics are interchangeable with name brands so as to want to call into question the veracity of the reports given by any individual.
A real good example of a difference in quality between products of the same compound is that of thyroxine. It is well established through observation of clinicians and subsequent investigation that Synthroid is much more variable in biological activity than Levoxyl.
Different is different.
- Scott
Posted by Phillipa on November 16, 2008, at 19:01:17
In reply to Re: Success Story-surprise result, posted by linkadge on November 16, 2008, at 14:54:19
Well in the case of synthroid you are specifically told by the doctors regular, pdoc or endo not to switch to generic if on brand and pharmacies don't even try to. Phillipa
Posted by Phillipa on November 16, 2008, at 19:06:45
In reply to Re: I noticed something with the name brand, too, posted by SLS on November 16, 2008, at 16:23:35
Scott amazing answered before read your post. I also agree know for a fact that xanax differs. Love Phillipa
Posted by linkadge on November 16, 2008, at 20:18:54
In reply to Re: I noticed something with the name brand, too, posted by SLS on November 16, 2008, at 16:23:35
>This was not a case of transient spontaneous >poop-out.
The patient believed they were having a change in their medications. Thats enough to do it for some people.
Linkadge
Posted by linkadge on November 16, 2008, at 20:21:41
In reply to Re: I noticed something with the name brand, too » SLS, posted by Phillipa on November 16, 2008, at 19:06:45
The issue of whether generics are equivilant is probably a phenomina more prevalant with psychiatric medicaitons.
You don't hear of somebody's blood pressure all of a sudden going through the roof after changing to an equivilant dose of a generic blood pressure medication do you??
Linkadge
Posted by Neverquit on November 16, 2008, at 22:21:18
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 20:21:41
> The issue of whether generics are equivilant is probably a phenomina more prevalant with psychiatric medicaitons.
>
> You don't hear of somebody's blood pressure all of a sudden going through the roof after changing to an equivilant dose of a generic blood pressure medication do you??
>
>
> Linkadge
>Did you read this link? You can also find other, clinical studies simply by searching "generic vs name brand" on Google scholar.
Posted by JadeKelly on November 16, 2008, at 23:16:45
In reply to Re: Success Story-surprise result, posted by bleauberry on November 16, 2008, at 11:28:07
Thank you Bleauberry,
I AGREE 100%. Its so strange to me that most agree, even those who believe they are experts, that we JUST DON'T KNOW about so many things, such as how a drug works exactly. If a person has a subjective experience that a brand name works better for them, maybe only some, who are we to say differently? What about Nardil? I doubt that was a large scale conspiracy. And I believe this to be true of some non psych meds, brand is just better for some people, who knows why?
~Jade
Posted by seldomseen on November 17, 2008, at 6:37:46
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 20:21:41
"The issue of whether generics are equivilant is probably a phenomina more prevalant with psychiatric medicaitons.
You don't hear of somebody's blood pressure all of a sudden going through the roof after changing to an equivilant dose of a generic blood pressure medication do you??"Well....
Patients who switched from Toprol XL to generic experienced serious side effects, such as a dramatic increase in blood pressure, an increase in heart rate and ectopic beats, nausea, dizziness, hives, and headache. These problems generally stopped when the patient switched back to Toprol XL.
Pharmacists are not allowed to switch a patient from name brand coumadin to generic Warfarin (anticoagulant) because of documented differences between the two.
Also, a patient can not switch between Lanoxin and generic digoxin (heart failure meds).
So, the psychotropics haven't cornered the market of problems with generics.
Seldom.
Posted by seldomseen on November 17, 2008, at 6:38:11
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 20:21:41
"The issue of whether generics are equivilant is probably a phenomina more prevalant with psychiatric medicaitons.
You don't hear of somebody's blood pressure all of a sudden going through the roof after changing to an equivilant dose of a generic blood pressure medication do you??"Well....
Patients who switched from Toprol XL to generic experienced serious side effects, such as a dramatic increase in blood pressure, an increase in heart rate and ectopic beats, nausea, dizziness, hives, and headache. These problems generally stopped when the patient switched back to Toprol XL.
Pharmacists are not allowed to switch a patient from name brand coumadin to generic Warfarin (anticoagulant) because of documented differences between the two.
Also, a patient can not switch between Lanoxin and generic digoxin (heart failure meds).
So, the psychotropics haven't cornered the market of problems with generics.
Seldom.
Posted by SLS on November 17, 2008, at 6:44:19
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 20:18:54
> >This was not a case of transient spontaneous >poop-out.
>
> The patient believed they were having a change in their medications. Thats enough to do it for some people.You have no idea what this patient believed. How could you? Please don't generalize. In this story, the patient fully expected to remain feeling well after changing to the generic. She believed her doctor that there was absolutely no difference in effectiveness between the two preparations. It is funny that I had to convince her that it might be the change to the generic that was allowing her to relapse. The thought never crossed her mind. I had to twist her arm to go back to the doctor.
- Scott
Posted by linkadge on November 17, 2008, at 7:00:10
In reply to Re: I noticed something with the name brand, too » linkadge, posted by SLS on November 17, 2008, at 6:44:19
Well, perhaps she was just having a bad week or month or whatever.
I remember having continual brief relapses on all the SSRI's I took. I didn't have to change the dose for that to happen.
Linkadge
Posted by linkadge on November 17, 2008, at 7:03:07
In reply to Re: I noticed something with the name brand, too, posted by Neverquit on November 16, 2008, at 22:21:18
Like I said above. If you are correct, then you will still be doing fine in a few months.
If you relapse again, I would start to rethink your theory, thats all.
Linkadge
Posted by SLS on November 17, 2008, at 7:45:36
In reply to Re: I noticed something with the name brand, too » SLS, posted by linkadge on November 17, 2008, at 7:00:10
> Well, perhaps she was just having a bad week or month or whatever.
It was bad. Luckily, we discovered why, and were able to remedy the situation. Hers is a success story that has yielded one very happy person.
> I remember having continual brief relapses on all the SSRI's I took.
So, you figure everyone is like you? It this your rationale?
> I didn't have to change the dose for that to happen.
Maybe your problems have no biological basis at all. That would explain a great deal. Antidepressants would have little, if any, therapeutic effect on you. Perhaps all of your brief improvements experienced while taking antidepressants were placebo effects. If you had numerous brief relapses as you report, then I imagine you had numerous remissions using precisely those drugs that you are sure don't work.
- Scott
Posted by linkadge on November 17, 2008, at 9:31:08
In reply to Re: I noticed something with the name brand, too » linkadge, posted by SLS on November 17, 2008, at 7:45:36
>It was bad. Luckily, we discovered why, and were >able to remedy the situation. Hers is a success >story that has yielded one very happy person.
You discovered what you think was the problem.
>So, you figure everyone is like you? It this >your rationale?No, my rationale it is not uncommon for people to have temporary relapses (hey, you could be my prime example!). Many people don't like to believe that they can relapse while on medication, so they find something else to attribute it to.
>Maybe your problems have no biological basis at >all. That would explain a great deal. >Antidepressants would have little, if any, >therapeutic effect on you.Your logic is pathetic and institutionalized
Medical science doesn't have all the answers. So, just because I don't respond to serotonin/norepinephrine boosting medications, there's nothing wrong?Many people on this board have had poor responces to serotonin/norepinephrine boosters. By your logic, theres nothing biologically wrong with them either.
Linkadge
Posted by SLS on November 17, 2008, at 12:20:48
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 17, 2008, at 9:31:08
> >Maybe your problems have no biological basis at >all. That would explain a great deal. >Antidepressants would have little, if any, >therapeutic effect on you.
> Your logic is pathetic and institutionalizedIs this another one of your "facts" and "truths" as you have come to know them?
I was being serious and perhaps even empathetic. I think you should at least examine the idea. I don't fully understand your emotionally intense response to my post. I wasn't accusing you of being anything evil or reproachable. There simply is no shame in having an Axis II disorder. I was postulating an alternative explanation for your suffering.
- Scott
Posted by bleauberry on November 17, 2008, at 18:15:24
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 20:18:54
Hey Link, I have always liked your posts and still do, so keep them coming. But I gotta say, on this particular topic, you might as well throw in the towel. There is WAY too much evidence to discount in the way you are trying to. Good effort though.
Just wanted to re-iterate something I said in a previous post that you seemed to gloss over. That is, I know of people who got switched to generic and didn't know. They had no history of offs and ons, the kind you spoke up. Their downturn after the switch was rather dramatic and scary.
They did not know they had been switched.I was with a friend last night. She told me she has been taking wellbutrin for a couple weeks. I asked her if it was regular, generic, SR, or extended release. She had to go get the bottle and let me look at it, because she didn't know, and she didn't even know what to look for on the bottle. Just a small example to point out that people do take meds blindly based on their doc's prescription, but other than the overall name of the med they really have no clue if it is generic or brand or time released or anything. Those of us here of course are highly aware, and maybe because of that we take for granted that all other people are. They aren't. People can get switched from brand to generic and not know it. And I've seen it result in disturbing developments, as have other people here, and has happened so many times it is uncountable. The phenomenon is too large to discount as placebo or relapse or off/on or whatever.
And like the other poster said, there are medications that involve life-and-death where generic substitutions are not allowed. Gee, I wonder why. It's kind of like an ostrich burying the head in the sand thinking it is safe from its prey if it can't see it. They know generics are life-threatening in heart or blood pressure, yet they ignore that generics could be threatening in other fields. Human nature on display. Kind of sad.
Posted by elanor roosevelt on November 17, 2008, at 21:14:44
In reply to Re: I noticed something with the name brand, too, posted by bulldog2 on November 16, 2008, at 7:31:21
well, the generics don't just have different fillers. Current regulations permit a variation of approximately 20% either way in the bioavailability of the active ingredient.
Posted by JadeKelly on November 19, 2008, at 6:45:34
In reply to Success Story-surprise result, posted by Neverquit on November 15, 2008, at 16:16:13
My son has had Epilepsy since he was 3 yrs old. Less than 2 weeks ago we were given generic depakote by mail. Required by Insurance. He had a Gand Mal Siezure last night. First one in years. I doubt he was having a placebo effect. Hope even skeptics see the logic in this.
Be Happy Neverquit.....
~Jade
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.