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.
For a break-down of the costs of generic vs. name brand antidepressants please refer to Consumer Reports: Drug Comparison.
It is most likely the case that your insurance company will have an FAQ section about brand-name vs. generic drugs as mine does. I am assured in writing, for example, that the FDA has stringent requirements to approve generic drugs including the following:
- The generic drug must have the same active ingredients in the same amount as the brand-name drug.
- The generic version must be identical to the brand-name in options for dosage and how it is administered (for example a tablet taken orally).
- The generic drug must disclose the same warnings and precautions on their label as the name-brand drug.
- The generic medication must have the same absorption rates (this was not true for Budeprion according to the research) and the amount absorbed must be delivered at the same time interval as the name-brand drug.
- The generic version must match the same batch requirements for strength, quality, and purity as the name-brand equivalent.
As reassuring as this seems there are still people who are not convinced that generics equal the quality of a name-brand product. Self Magazine, for example,
conducted a yearlong investigation which raised many questions about the safety and effectiveness of generics. They reported that many generic-drug factories are located overseas and that the FDA's inspection rates dropped 57% between 2001 and 2008. According to Self magazine, these inspections are not happening with the frequency that they should and drug recalls are the result.
In a three part series on the efficacy of generics vs. name brand medications, MedPage Today reports that both physicians and patients may find problems switching between brand name to generic medications particularly among antiepileptics, psychotropics, antiarrhythmics, and anticoagulants. There may also be problems when one switches from one generic to another when the two versions are produced by different manufacturers. Issues with efficacy and safety come to play when there is a narrow margin for therapeutic effectiveness. For example in the case of my son's Lamictal to treat his seizures, research has shown that break-through seizures are more likely to occur when using the generic version. In the case of antidepressants- nortriptyline and bupriopion (Wellbutrin) may be more vulnerable to dosage variations. As we have discussed with regard to Wellbutrin, any dose related variations can make one more susceptible to the risk of seizures.
There does not seem to be any clear cut consensus as to whether generics are always equivalent in efficacy, quality and safety to name-brand medications despite reassurances from the FDA. Some doctors, patients, and researchers still have questions about these potential differences.
When in doubt, always ask your doctor or pharmacist about your medications and which type of drug is best for you. In a lot of cases it may be a moot point. Insurance companies often switch you to the generic version of your medication and sometimes without even informing you. Always ask what changes you may expect, if any, when changing from a name brand medication to the generic version.
We would love to hear your thoughts on this topic. Have you had any adverse experiences in switching from a name brand version of your antidepressant to the generic? Or do you feel that there is little to no difference? Tell us your story. We value your thoughts and opinions.