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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 20 to 44 of 44. Go back in thread:
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
Posted by rskontos on November 20, 2008, at 12:33:53
In reply to Re: TO EVERYONE FOLLOWING THIS THREAD, posted by JadeKelly on November 19, 2008, at 6:45:34
I have a friend whose child is on Lamictal for seizures and the mail order pharmacy sent generic lamictal and the child broke out in dinner plate size rashes all over her body. When they did not give her the next dosage of the generic lamictal the next day after finally deciding that might be the problem and not a food allergy, the rash began to fade. The generic lamictal was the first time usage for this child. Who is 14 years.
She is also very severely handicapped and has no expectations of the medication.
rsk
Posted by Phillipa on November 20, 2008, at 19:14:06
In reply to Re: TO EVERYONE FOLLOWING THIS THREAD, posted by rskontos on November 20, 2008, at 12:33:53
RSK that is horrible poor child. Assume she went back on name brand? Love Phillipa
Posted by stargazer2 on November 20, 2008, at 19:40:50
In reply to Re: TO EVERYONE FOLLOWING THIS THREAD, posted by rskontos on November 20, 2008, at 12:33:53
Generics ARE NOT the same as the brand names meds despite being told they.
It's just a fact of life, but insurances (and pharmacists and many doctors) will always tell us they are the same. That is what generics are supposed to be...the same medication as the original one. With antibiotics and other meds, the differences are not as obvious. But with meds used for highly critical functions, i.e. seizures and psychiatric conditions, a slight change in the composition of both active and inactive ingredients can completely haywire a person's response, proven by a dramatic effect (like a seizure)to a medication that they have taken reliably and confidently for years.
Have there been any studies comparing brand and generic meds, two side by side? If so, I would like to read them, although they are probably almost impossible to read.
I know alot of the additives and agents used to bind ingredients together can affect the way a med is metabolized or absorbed.
And now with more of the generic meds being made oversees, we really don't know what we are getting. How about some melamine or whatever it is called, in your generic Prozac or wellbutrin.
Those examples of children having seizures on generics when none were had on the brand versions is clear to me to prove a direct correlation.
Many insurors allow you to pay for the brand version today but of course it will cost you, but is probably worth it for many meds, esp. psychotropics, like many of our lives depend on.
I would think the insuror would pay for a brand name med if a child was hospitalized after changing to a generic med.
I had problems with Wellbutrin and Nardil. Even though Nardil is not considered a generic, I consider it one, since the formula was changed in 2003 and now the effectiveness of it is vastly different. Comparisons between the original version and the current version/generic did show a difference in the binding agents, which caused a quicker breakdown of the ingredients. This seems to have effected the dosages and has a greater impact on vascular response, affecting the BP.
Don't get me started. I had great success on the original Nardil and now have side effects and needed to change meds over and over again.
I finally took charge of my treatment which has resulted in a remission of my depression after 20 + years. I can't say it is cured but I do have more faith in my ability to treat myself, rather than relying solely on the experts I have consulted and paid lots of money to over the years.
Thank God I have the ability to research on line and experiment with meds and other treatments over the past few years. That has given me the best chance at recovery.
And thanks to PsychoBabble and many "expert" here for advice over the years.
Stargazer
Posted by Abby Cunningham on November 21, 2008, at 10:43:22
In reply to Re: TO EVERYONE FOLLOWING THIS THREAD, posted by stargazer2 on November 20, 2008, at 19:40:50
I am totally convinced of the difference in generics/brand name meds, some way more serious than others - evidenced above. Sorry Link, I usually go along with you on many things but not this.
I have experienced it myself with xanax - alprazolam - took a generic and even from drug co. to drug co. they are different! I went on the name brand, then found out about Greenstone which is the company owned by the original manufacturer of xanax, and I've had no problems with it since.
I take generic wellbutrin and i am thinking of asking my pdoc to switch me to name brand.
Abby
Posted by elanor roosevelt on November 22, 2008, at 21:49:28
In reply to Re: TO EVERYONE FOLLOWING THIS THREAD, posted by JadeKelly on November 19, 2008, at 6:45:34
I am so sorry your son got bad meds.
That is unforgivable.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
Posted by Neverquit on March 6, 2009, at 19:43:12
In reply to Success Story-surprise result, posted by Neverquit on November 15, 2008, at 16:16:13
Update:
Still going strong. Hope this advice has helped some people out. :)
This is the end of the thread.
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