Name Brand Versus Generic Antidepressants: Is There a Difference?

By Merely Me Tuesday, January 17, 2012

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This question has been on my mind lately after my son’s neurologist recommended a name-brand medication to treat his seizures instead of the generic version. He wrote the prescription with the words, “NAME BRAND ONLY” on it so that there would be no mistake. His reasoning was that in his experience he witnessed many more break-through seizures among those patients taking the generic anti-epileptic drugs vs. name brands. This was something I did not expect the doctor to say. After all, aren’t we told that generic is just as good as the name brand meds in terms of effectiveness? But when I looked in the literature and particularly epilepsy forums I found that many patients agreed with my son’s doctor’s assessment. So it got me to wondering about antidepressants.

Are antidepressants as effective in the generic form as their brand name counterparts? The answer, it seems, depends upon who you ask.

In 2007 for example, one of our depression writers, Deborah Gray, wrote about how one of the generic versions of Wellbutrin XL, Budeprion XL, did not perform as well as the name brand medication in terms of effectiveness. It may have been cheaper but for many people, taking this generic version discovered that their depression symptoms returned. At this time MSNBC reported that hundreds of complaints were coming into The People’s Pharmacy, a syndicated column about medications. A study by ConsumerLab.com validated consumer complaints, that this new generic version was less effective in treating depression symptoms than the name brand.

One of the problems with this particular generic version of Wellbutrin XL was that the active ingredient was released too early leaving patients more susceptible to undesirable side effects including lowering the threshold for seizure activity. For those patients who felt that the generic version was inferior and less effective, this study validated their concerns.

Typically when one brings up this topic of generic vs. name brand medications there are many people who will state that the generic version has to contain the same active ingredients as the name brand and therefore should be just as effective but cheaper. Others will tell you that the patients and consumers who share their concerns about generic medications are just complainers and are imagining things. Still others are vehement that some generics are not the same as the brand name and are less effective and carry more potential risks for side effects. This clearly is a controversial topic which is not going away any time soon.

One of the other obvious problems in all this is that in most cases the insurance companies are making that switch for you to the cheaper generic version. And in cases where there is no generic version available some insurance companies are finding ways to refuse paying for the brand name drugs outright. Since we were discussing Wellbutrin I called my local pharmacy to see about the price difference in price between generic and brand name. A 90-day prescription of Bupropion HCL XL (the generic version of Wellbutrin XL) would cost me less than $20 with my insurance. However, if wanted the name brand I was told it would cost me $576 out of pocket. So yes there is a huge monetary difference there.

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Comments (21) | Add comment

jpw2008

1/17/12 2:07pm

hi MM

I am anxious because I spend alot of money

I guess I never thought about generic medicine versus name brand

I just cant stop spending

I was wondering if its part of my problem

Jon

Merely Me

1/17/12 5:48pm

Hi Jon

What sorts of things are you buying? Are they impulse buys? One way to prevent shopping impulsively is to only spend cash and no credit cards. But this is easier said than done.

Does shopping make you feel happy when you do it...or more guilty?

Tell us more...we are interested in hearing your story.

Rena

1/17/12 3:22pm

I have hear that name brand prescriptions have more of the impurities removed from them therefore taking more time and $ to process them, which costs more to the consumer. The generic medications cost less time and $ to process and contain other components in them that are not suppose to be harmful, can cause additional allergic reactions.

Merely Me

1/17/12 5:51pm

Hi there

This is worth investigating. I do not know much about the different processes but it seems they may be different in some cases?

It seems that there is no one right answer when it comes to...which is better...the generic or brand name meds. As consumers, patients, and caregivers...we hope they are of the same quality but...sometimes there may be quirks in the system it seems.

Thanks so much for your comment. I am hoping more members weigh in with their experiences.

Rena

1/17/12 9:14pm

I heard this from my primary Medical Doctor. It would be worth investigating.

Merely Me

1/22/12 5:27pm

See that is the thing...when we are hearing this from our medical doctors....I am listening.

Thanks for sharing Rena.

Fight the Power

5/ 9/13 7:57am

Pharmaceutical companies fund med schools. How are those doctors going to come out neutral? Not of big pharma has anything to do with it...And It Does!

filmneye

1/18/12 6:37am

Hi MerelyMe,

I've been on Wellbutrin HCL (not XL) for about 3 years now, taking 1/2 the minimum dosage of 75mg. daily b/c of my highly sensitive system. I started off w/the name-brand version of the drug & did very well on it; it helped a great deal as an "activator" & elevated me out of the "stay-and-curl-up-in-bed" type of depression I was experiencing.

Somewhere down the line, I guess after a year or so of taking the name-brand vers., I was switched over to the generic vers. of the drug. I don't think there was any significant difference between the 2 versions in terms of the drug's effectiveness or side effects for a good length of time after the changeover. But within the last 6 mos. or so, I've been experiencing more of the depression that the Wellbutrin used to do such a good job of staving off for me, and I'm pretty sure that about 6 mos. or so ago, I noticed that the name of the generic drug manufacturer had changed.

So, your topic question has gotten me to thinking about whether the change of the generic drug manufacturer could have affected the potency or absorption rate of the drug & have something to do with my depression symptoms coming back. Or, maybe it's not the change in drug manufacturer, but my Life circumstances. It's hard to say, I guess, but something to think about or wonder.

Andrew

Merely Me

1/22/12 5:31pm

Hi Andrew

This may be a difficult mystery to sort out. But it may be worth it to ask your doctor or pharmacist about it.

It seems to be the case that so many people will start out on the name brand drug and then the insurance doesn't want to pay for the name brand so you are forced to go generic or...you are forced to choose something else entirely. I am about to face this with my Provigil which is prescribed to me for my MS fatigue. It takes a lot for me to try a medication and this one is working. I will be very sad indeed if I can no longer use it due to my insurance.

Please do check with your doctor about your medication and if you can...let us know what he or she says.

Thank you for sharing.

Judy

1/18/12 9:59am

Hi, MM. How would one know if an antidepressant was less effective because it's generic rather than a name-brand? I'm on bupropion and it seems to be okay. But I do know that different manufacturers can be a problem if you have allergies. My husband has taken propanalol for years and suddenly became allergic to, it turned out, the coating on the pill made by one particular manufacturer. It's a real pain in the you-know-what because half the time, the pharmacy doesn't see their own notes about it and he'll get home and find it's the wrong manufacturer. He gets hives from it.

Because you may have a tendency to seizures, you might be able to get your insurance to make an exception to their rule about not covering the brand name Wellbutrin. I know they'll do it if there's a problem with a generic. My son, for instance, had a severe case of athlete's foot several years ago and the "allowed" prescription did not work, so I paid full price for the brand name. It took forever for that to work, even, and the doctor got a pre-authorization to have it okayed for use, but I was really mad because the doctor knew that the generic probably wasn't going to work but we had to try it, anyway. His condition was so bad that it traveled up his leg and turned it purple and we had him in the emergency room.

I suspect that insurance companies count on most people not appealing their decisions, as almost every time I have done it, I've gotten what I wanted, and that included additional therapy sessions beyond the covered number. It also helps if your doctor is good at knowing how to successfully maneuver the system. It's too bad we have to go to such lengths but, in my opinion, that's what we got when we "signed on" with HMO's and PPO's - another layer of people to pay salaries to for our health care.

Merely Me

1/22/12 5:39pm

Hi Judy

Your example is an excellent one...about your husband being allergic to the type of pill coating. Yes it sometimes makes a huge difference in where the medication was manufactured.

The example about your son too...is another case of where there was a difference between the generic and name brand.

Well you know how much I love to fight with my insurance company. :>) For anyone who has time you can read about my interesting battle with my insurance company to provide coverage for my acne medication. I still don't have my medication as I have to prove that I am not pregnant but they refused to tell me this fact. Had the pregnancy test and now I am just waiting for the hospital to send me my official results to send on to my insurance company. Oh the fun hoops one must jump through to get medication.

Thanks so much Judy for sharing your experiences here. You are very appreciated!

Lene Andersen, Health Guide

1/18/12 1:06pm

my drug plan only pays for generic, whenever possible - I understand up to a point. When you are using taxpayers money, you have to be frugal. However, I have tried some of the generics and have had bad experiences with them. One was the generic version of Pantoloc, the medication I take to deal with the stomach related side effects of rheumatoid arthritis medication. Although it seemed to do the trick in terms of the nasty symptoms, it gave me equally nasty side effects that I don't get with the name brand. so these days, I buy the name brand myself. Although my most expensive medication is covered (and not available in generic yet), I still end up spending about $400 on medications every month.

having a chronic illness is really expensive.

Merely Me

1/22/12 5:42pm

Oh my Lene

That is a lot of money.

There has to be a better way. Is it me or does it seem much more difficult nowadays to get the medications we need? Or the brand name meds are so jacked up in price you can't afford them.

Hey thanks for popping by. Always love to hear from you!

Christina Lasich, MD, Health Pro

1/19/12 4:29pm

Merely Me,

Thank you for inviting me to comment about this wonderful debate about generic vs brand name drugs. You did not mention one very important active ingredient in all drugs: the placebo effect.

By definition, a placebo is a treatment that is believed to be effective but is actually a sham and a “placebo effect” is the response to a placebo.... As long as that treatment is believed to be effective, then at least a portion of the response to that treatment could be based solely on expectations and a placebo response. (An excerpt from my article called The Practical side of the Placebo Effect)

By choosing sides in this debate about generic vs brand name drugs, I could potentially influence the belief system of many people. Doing so would not serve the greater good.

Thus if one believes the brand name drugs work better than the generic drugs, then that belief might be true. On the other hand, if one believes that the generic drugs are just as effective, then this belief could also be true for that individual. What matters is what an individual believes. Belief is a strong active ingredient.

Sorry I could give you a more definitive answer to this ongoing debate, but I BELIEVE it is a thoughtful one because believing can be relieving.

Dr. Christina Lasich, MD

Merely Me

1/22/12 5:55pm

Hey Dr. Lasich!

I am very happy to see you. Believing is relieving...I like that. Very true about placebo effects. I suppose it would be an interesting experiment to not tell subjects whether they are taking a brand name or placebo and see if they can tell the difference in effectiveness or quality.

However...

In some situations I do think there is a difference between the generics and name brand medications. As Judy has pointed out in her example...sometimes the manufacturer will make a slight change...maybe in the coating of the pill and her husband was allergic to that particular brand. In other cases such as with my son who has autism...he has no preconceptions about medications. His anti-seizure meds will either work or they won't. Research has shown in some cases break through seizures will occur more often with the generic version than with the brand name. This is why my son's neurologist insisted upon the brand name and I am glad of that.

I think the answer to this question...which is more effective and safe...name brands or generics is...it depends. It depends upon the particular medication, the individual taking it and any sensitivities or allergies to certain ingredients and what you are treating.

But yes certainly...in some cases that placebo effect could be a factor in all this.

Thank you...thank you for stopping by. Love your posts. You always get me thinking.

Wrote a question of the week in your honor. If you care to comment our members would be most appreciative as would I. :>)

Donna-1

1/20/12 9:53pm

This article is interesting: http://www.roadback.org/index.cfm/fuseaction/studies.display/display_id/120.html

especially under the topic: Bioequivalence.

I really don't have much experience to judge from (because I was put on a generic antidepressant, not a brand name, to begin with) but every time I see the pills are a different size/color I know the mfg has changed...again. And it makes me very nervous. What if I'm allergic to a different inert ingredient? What if a slight difference throws me back into major depression? These things run through my mind.

Merely Me

1/22/12 5:59pm

Hey Donna

I need to take a look at your link.

I think you are wise to...wonder these things. If you have concerns you should ask your doctor or pharmacist. But sometimes I wonder if even they always know.

Our son's neurologist is really on the ball and I trust him. I am grateful that he told us upfront about the medications.

Thanks for sharing.

Aloma Cline

2/ 2/12 11:26pm

I have been on Thyroid since 1950 when they did BMR and mine was so low I could not have been able to become pregnant! Much later some one decided I should take synthroid which is just what it says "synthetic" it has been many years of fighting and I am now back on Armour and it so much cheaper it is amazing as well as the benefits. I have to have a prior authorization. No one should be on generic and get synthetic polypropeline glycol capsules! I am much better and I have had many years of problems. NO GENERICS! This is tragic and very costly. I am off of all prescription meds but Armour and then supplements. Blood pressure excellent, heart fine, hair and skin fine, energy from proper protein and potassium and not red meat, acid to alkaline ph in balance (this took work) and the advice from a neurologuist, plenty of water, no sugar or salt in excess and reading labels. This is not an expensive way to live and still enjoy good food and no colds or skin problems and the gout (neuralgia) is improving constantly.

Tired of Head Pain

2/ 3/12 2:53pm

Aloma - I totally agree with you. It is my understanding that when a medication goes off patent the original manufacturer has "made back" the original investment money put into developing the drug, or should have, and so the drug is then open to other companies to create a generic version to be approved by the FDA to market at a much lower cost to the consumer. If that is true, then why does original drug cost remain so high, and why does the consumer have to pay such a premium to continue using it? I have had problems with various "generic" drugs in the past, and have had to ignore them because of affordability.

I have two questions. Once the original drug goes off patent, why can't the drug be manufactured the same as the original drug but for a lower price by contract with a generic manufacturer and solve all these problems, or why does the original drug company not lower the price to the generic level with the same formula and thus become it's own generic marketer, and avoid all these problems. It is a marketing problem, but one I don't understand, given all the problems with insurance companies, drug companies and people going without proper or no medications because of cost in this country. Seems a better way could be easily found by cutting out a lot of people in the middle making a profit of of people who need the medicine and are paying a lot for something that is not what they are told it is in the first place.

Sorry for the convoluted sentence. i hope you understand my meaning. The only ones making money in this instance are the generice drug mfrs. and the insurance companies.

Tired of Head Pain

2/ 3/12 2:54pm

Sorry for the convoluted sentence. i hope you understand my meaning. The only ones making money in this instance are the generice drug mfrs. and the insurance companies.

guest

2/ 8/13 3:11pm

My personal experience (and in a broader population, my psychiatrist's experience) is the generic sertraline does not work very well, if at all. The generic sold by Greenstone is in fact made by Pfizer, and does work; it may no longer be available.

The FDA requirements and actual implementation more or less guarantee that the generics can be inert for all practical purposes. The rules do not require actual testing, but only random inspections of a factory as a whole. The FDA looks for evidence that all of the manufacturing protocols are in place, that the factory appears to be in compliance with these, and has in stock ingredients that are needed for the pills. As you can see, the issue is not dyes or varying inert "pilling" materials. Plus, beside all of this, the FDA makes it virtually impossible to log "adverse events". Factories in countries famous for corruption make a joke out of the whole thing.

I buy the brand and pay the cost, because the pills actually work.

Name Brand Versus Generic Antidepressants: Is There a Difference?

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