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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by Neverquit on November 15, 2008, at 16:16:13
I feel lucky in that a last ditch effort to battle chronic-depression seems to have worked for me.After trying many different drugs, and some augmentation to various drugs, I was very surprised and actually amazed that a simple thing really seemed to make a difference for me....
Switching from generic fluoxetine to name brand Prozac. Only thing I am taking at 80 mg/day.
My "trials" included generic fluox., the former augmented with Abilify, then Wellbutrin, Cymbalta, Cymbalta/Abilify combo. I was very excited about "Abilify" as the mechanism seemed similar to Amisulpride which seems to work particularly well for dysthymia (I live in the US). It worked for a brief period (very brief) then stopped.
In the past I have taken Celexa, Lexapro, several tricyclics, Effexor, Remeron etc.
Only thing that worked COMPLETELY, then and now, was the name brand (Lilly, now "Dista") Prozac.
Hope this option helps someone.
:)
Posted by Phillipa on November 15, 2008, at 18:00:06
In reply to Success Story-surprise result, posted by Neverquit on November 15, 2008, at 16:16:13
Absolutely fantastic!!!! Don't like generics either. So the real deal worked. What dose and how long? What was the difference you felt right away? Love Phillipa ps when first out took the real deal 20mg and had loads of engergy, second day anxiety, and third day panic. I stopped as wasn't depressed then at all. Pdoc was a good one and begged me to take 20mg every third day. Didn't. Only came in 20mg gel caps at the time.
Posted by Neverquit on November 15, 2008, at 18:10:41
In reply to Re: Success Story-surprise result » Neverquit, posted by Phillipa on November 15, 2008, at 18:00:06
> Absolutely fantastic!!!! Don't like generics either. So the real deal worked. What dose and how long? What was the difference you felt right away? Love Phillipa ps when first out took the real deal 20mg and had loads of engergy, second day anxiety, and third day panic. I stopped as wasn't depressed then at all. Pdoc was a good one and begged me to take 20mg every third day. Didn't. Only came in 20mg gel caps at the time.
Years ago I had used the name brand; 80 mg/day. It worked SO well, that I basically stopped taking anything. When I experienced again depression 2 years ago, I first tried "fluoxetine" generic, fully expecting it to work but was very disappointed. I then tried lots of other things, which either had bad side effects or simply didn't work.As a last resort, doing my own research, I came upon a few anecdotes and a Canadian study saying the name brand seemed to work better in many cases, so I said "why not"? But really didn't expect anything. I noticed a difference within a few days. I'm sure the fact that I was transitioning from the generic gave me a head start. My p-doc was very surprised, though in subsequent discussions she said there usually is a transition period between the name brand and the generic, which indicates to me SOME difference in mechanism.
Whatever the reason; it worked.
Posted by Roslynn on November 15, 2008, at 18:55:56
In reply to Re: Success Story-surprise result, posted by Neverquit on November 15, 2008, at 18:10:41
I noticed also when I used to take Prozac that the generic was not the same and made me quite tired.
Posted by Phillipa on November 15, 2008, at 19:18:09
In reply to Re: Success Story-surprise result, posted by Roslynn on November 15, 2008, at 18:55:56
IN my opinion only it just saves insurance companies money. Phillipa
Posted by Racer on November 15, 2008, at 21:20:13
In reply to Success Story-surprise result, posted by Neverquit on November 15, 2008, at 16:16:13
Only in my case, I noticed that the allergic reaction I had to the generic went away! Kinda hard to miss, since the hives all over my face and chest were not inconspicuous...
(And I'll mention, it was only that one generic -- other generic fluoxetines haven't done that.)
In theory, the generics must be within 10% bioequivalent to the name brands, which in practice may mean that one generic may vary up to 20% from another. BUT, since those bioequivalance tests are done in vitro, who knows the actual absorption in vivo? The fillers may somehow interfere with absorption, or something else equally unexpected. (Maybe some of those inert fillers or binders are actually depressogenic?)
So, one possibility is that another generic would work for you, if the cost of the name brand is a problem. That's how my doctor solved the problem, once I had that reaction. The name brand didn't give me hives, so he wrote the scrip for capsule only and no hives.
On the other hand, it didn't work for me, but that's an entirely different matter...
(And I totally forgot to congratulate you! Yippee!)
Posted by Zyprexa on November 16, 2008, at 0:33:19
In reply to I noticed something with the name brand, too » Neverquit, posted by Racer on November 15, 2008, at 21:20:13
I had a problem with generic prozac. When I remembering the brand to work better. I took several different generics. And then they took me off it, or actualy I just quit.
Posted by linkadge on November 16, 2008, at 5:34:49
In reply to I noticed something with the name brand, too » Neverquit, posted by Racer on November 15, 2008, at 21:20:13
I think it is all in your mind. It is possible to be allergic to an ingredient but thats about it IMHO.
I just can't see one version working and another one not, especially if you have tried adjusting the dose. It is the exact same drug and I highly doubt the fillers are psychoactive.
The other thing too is that fluoxetine has a very long half life. So even if there is a slight inconsistency from dose to dose, this is unlikely to have a major impact on the long term blood level.
Just my 2 cents
Linkadge
Posted by linkadge on November 16, 2008, at 5:36:40
In reply to Re: I noticed something with the name brand, too, posted by Zyprexa on November 16, 2008, at 0:33:19
Well, if you feel better, thats all that matters.
Linkadge
Posted by bulldog2 on November 16, 2008, at 7:31:21
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 5:34:49
> I think it is all in your mind. It is possible to be allergic to an ingredient but thats about it IMHO.
>
> I just can't see one version working and another one not, especially if you have tried adjusting the dose. It is the exact same drug and I highly doubt the fillers are psychoactive.
>
> The other thing too is that fluoxetine has a very long half life. So even if there is a slight inconsistency from dose to dose, this is unlikely to have a major impact on the long term blood level.
>
> Just my 2 cents
>
> LinkadgeCould the difference in fillers have an impact on the absorption rate of the med? You hear all these nardil veterans complaining how much better the old formulation was than the new one.
Posted by linkadge on November 16, 2008, at 8:42:54
In reply to Re: I noticed something with the name brand, too, posted by bulldog2 on November 16, 2008, at 7:31:21
>Could the difference in fillers have an impact >on the absorption rate of the med? You hear all >these nardil veterans complaining how much >better the old formulation was than the new one.
I personally doubt that it would make a major difference, especially if you have played around with the dose. Many of the fillers used are routinly used as fillers with other drugs (brand name or not). I agree that there may be slight differences in the blood level from brand to brand, but that is nothing that an adjusted dose won't fix.
Linkadge
Posted by Neverquit on November 16, 2008, at 9:13:00
In reply to Re: I noticed something with the name brand, too, posted by linkadge on November 16, 2008, at 5:34:49
> I think it is all in your mind. It is possible to be allergic to an ingredient but thats about it IMHO.
>
> I just can't see one version working and another one not, especially if you have tried adjusting the dose. It is the exact same drug and I highly doubt the fillers are psychoactive.
>
> The other thing too is that fluoxetine has a very long half life. So even if there is a slight inconsistency from dose to dose, this is unlikely to have a major impact on the long term blood level.
>
> Just my 2 cents
>
> Linkadge
I understand the potential scepticism; hence the title of the thread.A few points:
As an FYI, I have a degree in Psych and am familiar with the placebo effect and the "what should be" regarding generics and name brands. I am not saying that to imply "expert power", I am saying that to give some context regarding my perspective.
In subsequent research, I have noticed that I am alone in observing this:
http://www.dr-bob.org/babble/20020301/msgs/96481.html
Posted by Neverquit on November 16, 2008, at 9:15:02
In reply to Re: I noticed something with the name brand, too, posted by Neverquit on November 16, 2008, at 9:13:00
> > I think it is all in your mind. It is possible to be allergic to an ingredient but thats about it IMHO.
> >
> > I just can't see one version working and another one not, especially if you have tried adjusting the dose. It is the exact same drug and I highly doubt the fillers are psychoactive.
> >
> > The other thing too is that fluoxetine has a very long half life. So even if there is a slight inconsistency from dose to dose, this is unlikely to have a major impact on the long term blood level.
> >
> > Just my 2 cents
> >
> > Linkadge
>
>
> I understand the potential scepticism; hence the title of the thread.
>
> A few points:
>
> As an FYI, I have a degree in Psych and am familiar with the placebo effect and the "what should be" regarding generics and name brands. I am not saying that to imply "expert power", I am saying that to give some context regarding my perspective.
>
> In subsequent research, I have noticed that I am alone in observing this:
>
> http://www.dr-bob.org/babble/20020301/msgs/96481.html
>
>Important: the above should say NOT ALONE in observing this. :)
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
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Dr. Bob is Robert Hsiung, MD,
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