Some Words on: Generics

There is still no end in sight to the debate on whether generic drugs are – or are not – an equivalent substitute for the original brands. Generics use the same active ingredients as the originally patented drugs, yet a large party of both physicians and patients claim they do not work in the same way. And in fact, there can be slight chemical differences between original and generic drugs. Every medication, psychiatric or not, contains substances that are not meant to have any effect on the consumer, but have other functions, such as helping the absorption of the active ingredients into the organism or binding them so the tablet does not crumble. These compounds are called excipients. This is where variation can occur. Some generic drugs may not use the same excipients as their original counterpart, or the ration between active ingredients and excipients can be different. However, this does not necessarily mean generics are any worse, or that their users unavoidably will experience negative effects they would not be suffering taking the original drugs.

It is hard to pick a side in the controversy, especially when you are a user of psychiatric drugs or know people who are. Obviously, you will be inclined to project your personal experiences into your argument. At the same time, being personally involved can give you a more hands-on approach to the matter and look at it without getting caught up in the technical details of medical studies and statistics, and without being influenced by professional links to the pharmaceutical industry or second-hand-anecdotes from colleagues in the medical field. This perspective is the one I am going to expose. I am not a health care professional, but I have been taking psychiatric drugs for slightly over four years, with an unknown amount of time still to follow. Moreover, some people who are very close to me have used them in the past or are still doing so, and I have seen psychiatric drugs in action on fellow patients in psychiatric hospitals. One thing I can say in advance – I have no clear-cut answer to the question if generics are as effective as the originally patented drugs. There is a huge number of companies producing generics, in different countries, under different safety standards, with differing levels of work ethics. Evidently, the aspect of safety is an important one, if not the most important one. Are generics as safe as original brands? Also this I cannot say. But then again, it is doubtful whether taking psychiatric medications in and of itself can ever be safe. The knowledge we have about possible side-effects and our ignorance of long-term effects on the human brain speak for themselves. If you must take psychiatric drugs, my first and best recommendation is to be careful about where you get them from. Further on I will go into more detail about this point. First, let me describe my personal experiences with generic drugs.

Pretty soon after starting on Seroquel and Zoloft, my physician switched to prescribing generic versions of the substances Quetiapine and Sertraline. Every three months, when I needed a new prescription, I would receive a generic by a different company, produced in another country. So far, I have never noticed any adverse effects, although I always feel wary about experimenting with my mental health. My level of trust in a generic is based – rightfully so or not – on where and by whom it was produced. All the generics I have used so far came from European countries, and they are available through the public health care system I am ensured in. All this certainly does not guarantee their effectiveness or safety, especially not considering that every individual potentially responds in unforeseeable ways even to minute changes in their medication plans. Still, I assume that the generics I am using must be safer than the ones you can acquire through the internet yourself. For those who want it, self-medicating is made relatively easy and also relatively cheap in financial terms. You can order psychiatric medications from India, for example, just as you can walk into a corner shop to buy candies. This is not to speak badly of any country, but I do believe one should be critical of online drug-discounters. As convenient as they may seem, their informality is also a risk to their customers. Within my close personal contacts is a tragic case of fatal medication abuse, greatly enabled by online drug commerce.

But even the safety of generic drugs that are approved by the health care system depends on how the individual using them reacts. A friend of mine tried a generic version of her antidepressant, for which she did have a prescription, and almost immediately experienced obsessive and profoundly unsettling thoughts. These disappeared almost overnight when she returned to the original brand. Did this incident occur because my friend had fallen prey to a low-quality generic or because her organism was very sensitive to changes? Hard to say. I cannot overemphasize how radically different people’s reactions to psychiatric medications can be. All you have to do to find out is log into one of the numerous forums on the topic. Drugs that are described as “zombifiers” by some are hailed as life-savers by others. Quetiapine and Sertraline, the substances I am currently taking, are no exceptions. I am doing fine on them, but I have read desperate posts on how they turn individuals suicidal, manic, emotionally numb, paranoid, and so on. The ugly truth is that psychiatric drugs – generics just as much as originals – are a Pandora’s Box. There is no way of knowing beforehand what exactly will result from using them.

And then, there are the many cases of people using original brands which either do not alleviate the symptoms of psychiatric illness or do so at the terrible price of disabling and humiliating side-effects. Defenders of original psychiatric drugs will argue they were patented and released onto the market only after a lengthy and thorough process of testing, and that therefore they are safe to use. This statement, unfortunately, is not accurate. Although a psychiatric drug can only make it into the pharmacies after having been institutionally approved, several incognitae remain. The biggest one probably is what the drug actually does to the brain, apart from potentially diminishing certain symptoms of mental illness. So far for example, no published study has explored the sequels of long-term psychiatric drug use. Typically, drugs are tested over the duration of several weeks or a few months, when numerous users are really taking them for years on end or even for life, in varying dosages and combinations. It is also unknown, and feared, what psychiatric drugs could do to a young brain in plain development. Children or teenagers being medicated has become common practice. Detractors object this might slow down or even stunt their cognitive, emotional and social growth and thereby cripple their lives before they have even begun. Last, but not least, it has to be remembered that the array of possible negative effects, also called side-effects, is virtually endless, some of them being extremely dangerous or horrifying at best.

On a theoretic level, considering the safety of psychiatric medications is debatable in the first place, I feel compelled to wonder if questioning the quality of generics makes any sense at all. From a practical perspective, I have seen evidence for their safety in myself and for their unsafety in others. My recommendation to you is to handle psychiatric drugs in general with utter care. I wish I could be more concise.

Here is a brief list of aspects you can take into account in order to protect yourself from unpleasant experiences or more serious dangers:

Means of acquisition – Only use psychiatric drugs you have obtained through prescriptions. Do not shop for them on the internet.

Ingredients – Make sure you are not allergic to any of the ingredients. For example, lactose is a common excipient. If you are lactose intolerant, you will need to find out which companies offer the same active ingredient with a different excipient.

Country of origin – Make sure your medication was produced in a country you find trustworthy in terms of quality standards. Unfortunately, there isn’t much you can do to find out if they really live up to your expectations.

Follow your doctor’s indications – Be observant of the doses and times your doctor established in your medication plan.

No spontaneous dose variations – Do not make any changes to your medication plan unless they have been systematically planned. For example, do not take more of your antidepressant when you feel down, or less of it because you are having an especially nice day.

Monitor your reactions at all times – Always watch out for any adverse reactions your medications may be causing. Constantly keep an eye on your general well-being. Also evaluate your performance at work or at school, your memory, your social capabilities and your emotional reactions to everyday situations. Have people you trust help you monitor all these aspects.

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How It’s Going – Completion of Phase Two

I am now permanently on 200 mg of Quetiapine (Seroquel) and 100 mg of Sertraline (Zoloft), which means I am concluding phase two of my withdrawal plan. According to this schedule, as I had originally laid it out, I am supposed to stabilize these doses over the course of two to three months. However, given that I am experiencing no withdrawal symptoms or other anomalies at all, I might reconsider the duration of the stabilization period and possibly reduce it to somewhere between one and two months.

My current doses correspond to a 30% reduction of the amount I was prescribed when I first started taking my medications. I believe my organism is already perceiving some degree of relief. My overall well-being has been improving, certainly also thanks to a healthy diet and regular exercise. Mentally and emotionally, I feel perfectly functional and healthy. My partner is a great source of support, and I know I can trust him to report any unusual observations to me.

I am also pleased to see how each prescription of a hundred coated tablets now lasts one month longer than it used to. The medication supply that was meant to be good for three months is now sufficient for four. One could say I am 30% less stressed about getting my new prescription.

As for this blog, it has been slowly, but steadily, attracting more readers. My hope is for them to find useful or at least interesting information on its pages, be it for themselves or in order to help loved ones. I want to stress once more that your comments, questions and suggestions are more than welcome. Reader’s contributions make this kind of blog so much richer and so much more helpful. Feel encouraged to send me your thoughts and experiences – they will all be considered and responded to.

When Meds Get in The Way

Life is full of little things we take for granted to such a degree that we don’t even ever think of them – until they’re gone. When you begin taking psychiatric drugs, an unexpected plethora of such details opens up before you. What you once considered pleasant, but petty aspects of everyday life suddenly are luxuries you will have to do without, or cut down on, from now onward. You will need to revise and likely modify several of your habits in order to stay safe, and you may feel restricted in your personal freedom. To put it in plain English: you will be forced to redefine the terms “fun” and “freedom” for yourself, at least partially. I know how off-putting this sounds, but the good news is that it is possible as long as you keep an open mind. The following is a list of everyday luxuries I have had to reevaluate since getting on psychiatric medication.

Luxury #1: Booze

Officially, you are not supposed to consume any alcohol while you are taking psychoactive medications. Booze may alter the way your organism assimilates the active ingredients, and it also acts as a depressant. So, if you are already suffering from depression, regular pub-crawling is a no-no. Now, alcohol is an almost ubiquitous substance. What is more, we humans use it as a vehicle for social bonding. Drinking with others is not just about tickling our taste buds and our nervous system, but it is a social ritual. No matter if we are with friends, family or business partners: sharing a drink equals declaring you are on the same page with them, and on friendly terms. As alcohol is known to lower inhibitions, it also serves to break down barriers between people. As a consequence, being offered one or the other alcoholic beverage on all sorts of occasions is virtually unavoidable. Depending on your psychological equilibrium, you may have to reject those offers altogether. Personally, I have found I can have a few glasses of wine or juice with a shot of rum without experiencing any negative effects. As I have never been a heavy drinker, needing to set limits to my alcohol consumption has not been a big issue for me. Essentially, I am having the same amounts as always, only that when I first started taking psychiatric medication I had none at all for a few months and then carefully started experimenting with half a glass here or one shot there, until I felt certain it was doing no harm to me. However, if you are a customary drinker, you will need to become more self-disciplined.

Luxury #2: Caffeine

If you have ever been hospitalized in a psychiatric clinic, you may have noticed they offer decaffeinated coffee or decaf teas to their patients. Needless to say, caffeine is a stimulant. Depending on your diagnosis and your medication regime, you may have to say goodbye to your cuppa or at least reduce your intake. For someone with anxiety or mania, stimulants are not an option. In my particular case, I have found that coffee and tea do not affect me negatively, so I continue having them just as always during the first half of the day. I avoid caffeine after 5 pm, though, and given that I dislike most sodas, I never have coca cola or the likes. I also stay away from energy drinks or any other stimulants stronger than my habitual cup of coffee. Evaluate carefully, if possible together with your therapist or prescribing doctor, if sticking to your caffeinated drinks is alright for you. Try one cup of mild coffee in the morning and observe how you react both during the day and at bedtime, then make a decision based on what you experienced.

Luxury #3: Sugar and carbohydrates

In another article on this blog, I had written about weight gain as a negative effect of psychiatric drugs. Unfortunately, to limit the damage, you should reduce your intake of processed carbs and sugars significantly. Truth be told, if you are interested in healthy nutrition you ought to do so anyways. If you are on medication, avoiding processed foods becomes imperative. Eliminate them from your daily diet. Maybe allow yourself one eat-what-you-want day per week in order to keep cravings at bay. As I have a very sweet tooth, abstinence in this area is tough for me. However, I have found it extremely helpful that my partner and I have both decided to go low carb. In our fridge and around the kitchen, you will find no chocolate, no cookies, no cakes, not even white bread. If I ever felt like being “naughty” I would have to go all the way to the next grocery store, pick something out and stand in line for it, which makes breaking the rules a lot less tempting. Also, once you get the knack of maintaining a low carb and low sugar diet and explore some new recipes, your cravings for processed foods will diminish over time. As of today, I hardly experience any unruly longings and enjoy otherwise forbidden treats all the more when I come across them at parties or other special occasions.

Luxury #4: Foods you had never thought of as dangerous

If point #3 has motivated you to switch from drinking sodas to enjoying natural fruit juices, and you are sipping from a glass of refreshing grapefruit juice as you are reading this paragraph – stop! Grapefruit juice interacts with numerous medications because it alters the way your liver processes them. Interestingly, this fact does not appear on the label of juice packages, so you need to find out through research on the internet or consultation with a pharmacist. There are other natural foods under suspicion of interacting with certain medications: pomegranate is one of them, though studies haven’t yet confirmed how much it really interacts with medication. Some herbal medicines, such as Saint John’s worth and Valerian, potentially exacerbate or weaken the effect of psychiatric drugs. The same goes for some supplements. The following are links to pages with further information about drug-food interactions.

Free PDF on drug and food interactions for downloading by the FDA: http://www.fda.gov/downloads/drugs/resourcesforyou/consumers/buyingusingmedicinesafely/ensuringsafeuseofmedicine/generaluseofmedicine/ucm229033.pdf

Article by the Academy of Nutrition And Dietetics: http://www.eatright.org/Public/content.aspx?id=6442477646

Again, none of this means you necessarily have to avoid these foods and beverages completely, but you need to be moderate in the amounts you consume and extremely attentive about possible negative effects.

Luxury #5: Spontaneous sleepovers or travelling

Before I say anything else: ALWAYS carry one or two extra doses of medication with you! It is rare to be unexpectedly confronted with the option of spending a night away from home or prolonging a trip for an extra day. Yet, in good theory, it can happen. Your flight may have been delayed or cancelled, you are too tired to drive home after a get-together or weather conditions are too bad to get on the road, or you simply wish to stay somewhere nice for a bit longer. All those situations can turn into a problem if you don’t have enough medication with you. Therefore, make sure to take an emergency backup wherever you go – near or far. The longer your trip, the larger your extra supply should be. On a normal work day I will carry a tiny pillbox with one spare dose in my purse. When I go on longer trips, I habitually put enough medications for an extra week in my luggage, and I also keep them in different bags in case one of them gets lost or stolen. Once we’re at it: also record your medication plan – names of substances, doses and schedule – in your agenda or on a piece of paper to keep in your wallet. Accidents happen, and the medical team scraping you up from the street must know about your using psychiatric drugs. Don’t forget to add other basic information, such as your blood type or any chronic conditions and allergies you have.

Luxury #6: Over the counter meds

Have a headache? Before you head to the pharmacy for some Aspirin, make sure you can actually take it. Many over-the-counter drugs interact with psychiatric medications, which can turn a vulgar flu into an adventurous slalom around dozens of red flags. For more information, go to my article on drug interactions.

Luxury #7: Sunbathing

This is an issue I luckily escaped. Some medications, including the ones I am taking, potentially render you more sensitive towards UV radiation. Depending on your individual case, you may need to apply sunscreen to your skin before leaving the house or quit sunbathing and tanning sessions. As I said, my tolerance – and love – towards sunlight is unaltered, but I advise you to monitor your response to it for as long as you are on medications.

Luxury #8: Overall independence

By overall independence I mean the ability to adapt to your surrounding circumstances without having to worry about where you get your medications from. It is only a few exceptional situations that would really challenge your flexibility in this regard: wars, cataclysmic natural events such as floods, hurricanes or earthquakes, social upheaval or economic collapse. Even though these events are not the most likely to occur, they are an inconvenient possibility. When your well-being hinges on the availability of any type of medical treatment, you realize how dependent you are on civilization, the integrity of your society and a functioning infrastructure. You cannot simply revert to an ancestral lifestyle or an existence of scarcity the way most others could – if grudgingly. Unfortunately, I have not yet come up with a way of getting around this problem. Probably, precaution is the best protection from shortages in supplies. Just as it is wise to keep a few gallons of drinking water and some emergency lanterns or candles in your house, also have a backup of your medications. In addition, stock up on your drugs in time. Do not leave picking up your prescription for last minute, but create  a safety margin of maybe a few weeks.

Luxury #9: Hardcore partying

For some, parties aren’t over before daylight. However, if your medication plan includes taking a sedative or tranquilizing drug in the evening, you may have to retire from power-partying and clubbing. Even if you can force yourself to stay awake, you may not be in condition to leave the house or, let alone, drive anywhere. And much less will you be able to enjoy the party. My longest night is usually New Year’s Eve, and even then I hardly make it beyond 2 or 3 am. I take my anti-psychotic at that time and then sleep in the next morning. On all other occasions, I am in bed before or roughly around midnight. Before you give in to feelings of rebellion, take into account that altering your sleep cycle also implies tampering with the regularity of your medication plan, which in turn can affect your psychological stability and performance at everyday activities. Ask yourself if it is worth it.

Luxury #10: Recreational drugs

I have never used any recreational drugs, but now that I am on psychoactive medications I also should not consider trying them. They interfere with your mental functions just as psychiatric medication does, which means all sorts of unforeseeable interactions are possible. Some recreational drugs are actually believed to trigger psychosis. Stay away from them if you can. I have met people who continued using recreational drugs, mostly marijuana, despite taking psychiatric medications, and who were claiming it was not harming them. Yet, in my opinion it is preferable to play it safe. Mental health is one of our most valuable goods! Should you be addicted to street drugs, please consult with your prescribing doctor and/or therapist before making any decisions. Special considerations need to be taken to handle your case.

These were the luxuries I could come up with based on my personal experience with psychiatric medication. If you can think of more aspects of everyday life that turn into luxuries when you are in treatment, please leave a comment.