My husband has been on an anti-depressant (Cymbalta) for years. Aside from the initial two-week adjustment period, it has worked great. Over the summer, he switched to the generic to save money. Slowly, over a two-week period, he fell back into his old patterns: getting angry about nothing, popping ibuprofen daily for pain issues, and being generally depressed. It finally came to the point where I asked, "Honey, have you taken your anti-depressant today?" To which he growled, "Yes, I have!"
Because I could see that something was seriously wrong (he did not notice), I did some research and discovered many complaints exist online about people taking antidepressants who have issues when they switch to generic. This was around the time of Robin Williams committing suicide, so I began to wonder if Mr. Williams had not also recently switched to generics.
The day we switched back to the name brand (at $12 per pill out of our pocket mind you), he was fine. No more ibuprofen, no more grumpiness, and no "readjustment" period. I reported the issue to the FDA immediately. The FDA told me that generics can vary their binders by 20% from the original. The generic drug company (who also contacted me) told me that some people metabolize these different binders more quickly than what they metabolize the originals - thus leading to a serious issue with the extended release system. Where the name brand will keep releasing slowly throughout the day to maintain your blood level of the drug, the generic may end up dumping it all too fast. This means you will have up and down medication blood levels. Based on my research since, this only effects 2% of the population (according to the few scientifically published studies on the topic). However, when you are dealing with a drug that prevents you from killing yourself, 2%, in my opinion, is significant. Ironically, the reason ALL anti-depressants carry a block box warning about increased suicide is because the suicide attempt rates among placebo vs. antidepressants is 2% greater in anti-depressants. I have to wonder if they were using the generic for those studies?
Over the summer, my son also had to go on anti-depressants because he began making some very depressive statements. The doctor naturally prescribed a generic for Lexapro. I thought nothing about it. For six-months, my son hid from me, my husband, his family doctor (the prescriber), and his psychologist, that he actually felt worse on the drugs because "he didn't want to change them." He began smoking rolled index cards (at 12 years old). He began getting in trouble daily at school, from fights to talking out of turn. He also began to think that no adult cared about him because we did not recognize that something was wrong. The only thing we thought was wrong (aside from puberty) was that his ADHD medications were not working - which we upped.
In January, my son began behaving very bizarrely in school. He came home, and when we collected his iPhone at 6:00 PM for the night, he went ballistic. First he ran away, and we went and got him. Then he attempted to hang himself from the top bunk with a bathrobe belt. Thankfully, I heard gagging noises and went in and found him before he passed out.
When you are on anti-depressants, you should NEVER feel like you want to kill yourself. This is the sign your anti-depressants are NOT WORKING and you NEED NEW ONES. However, you, like my son, are probably an expert at hiding your feelings. Please, tell someone - especially your doctor - if you have this feeling. Many people may care about you, but the ways they are trying to help you may not work unless you spell out to them what is wrong.
My son, of course, was hospitalized, and his medicine was changed to name brand Zoloft. In less than a week in the hospital, he went from being withdrawn, uncooperative, and self-harming to realizing EVERYTHING (from smoking to the suicide attempt) was wrong. The way he explained it was: "I didn't want to do those things, but I couldn't stop myself." The doctors and nurses at the hospital, who initially took my statements that it was a medication issue with a grain of salt, were amazed at his recovery. They told us on entry that the average stay was 14 days. My son was out in a week.
Ironically, the pharmacy (despite the fact it is in their computer to only give name brand Zoloft and despite the fact that is the way the doctor writes the script) gave my son generic this month "on accident." My husband picked it up and didn't notice. After several weeks on it, my son was again suicidal- this time over a missing tablet. He also began to self-harm. No one will ever convince me it wasn't the generic- the day he went back on name brand, he came in and told me how happy he was because he was feeling so much better.
Most insurances, including Medicaid and Medicare, do not want to pay from name brand medications. Some will require you to actually have a negative reaction before allowing you to get on it. Report any adverse reactions to your doctors and insurance companies IMMEDIATELY.
Most importantly, if you have had a bad reaction to a generic anti-depressant - i.e. you were on a name brand, you switched to the generic and had awful "side-effects," and then you were immediately relieved of these side effects once you went back to the name brand - you really must report it here. There is a list of what you can and can't report on the left, and you click on the "Consumer/ Patient" button on the right to get started. It takes some time and you will need to go to the pharmacy and ask them for a printout with the name of the manufacturer, the strength of the generic drug, the NDC number and the lot number to fill out the second page. However, if enough people are having trouble with this and report it, we can make a change in the way generic anti-depressants are treated.
Our society has become very focused on the need for mental health reform. However, we will continue to struggle with school shootings and other violent crimes (more than 50% of all prisoners have mental health issues that are untreated) as long as we keep thinking mental health issues, such as bi-polar, depression, and ADHD, are all "in someone's head." People on Medicaid and Medicare should be able to receive better mental health treatment (i.e. the government should loosen its purse strings so more mental health specialists are inclined to participate in their programs and so those participating don't end up filing for bankruptcy), and they should be able to receive name brand mental health drugs if the doctor can support one previous negative reaction to the generic. What may seem initially costly will save money on many levels in the end. It will also save families and loved ones much trauma.
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