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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