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.

Some Words on: Mental Illness as a Sales Hit

“Mental Illness” has become a ubiquitous term in mainstream media. In many instances, they are promoted with the same nonchalance as over-the-counter medications, and little is said about their negative effects. As a consequence, consumers are more likely to start using psychotropic medications. At the same time, doctors are getting increasingly casual about prescribing them under the pretext of a hastily made diagnosis. Strangely, having a (not too scary) mental disorder is now almost a fashionable accessory to your personal presentation. Remarking at a cocktail party you have ADHD or anxiety disorder at the same time as being a successful professional makes you incredibly interesting. Don’t try this with schizophrenia or other spooky sounding conditions, though, unless you want to have the couch you’re sitting on all to yourself. Read more on social isolation and psychiatric conditions in my post “Some Words on: The Social Stigma of Mental Illness”.

The idea that you can have a “normal” life despite being mentally ill is one of the strongest messages the pharmaceutical industry uses for marketing psychiatric drugs. But they don’t only target potential consumers; they also offer attractive deals to prescribers. Tagging a patient with some or the other “disorder” and sending them home with a prescription is profitable for psychiatrists just as it is for pharmaceutical companies. As a consequence, prescribers with less than very sound work ethics are prone to over-diagnosing patients. Conveniently, the Diagnostic and Statistical Manual of Mental Disorders (DSM) gets thicker with every new edition, so more diagnoses can be cooked up and more prescriptions issued. Evidently, this puts patients at risk of being inaccurately diagnosed and unnecessarily drugged. They fall prey to the trust they learned to have towards health care professionals since early childhood. If something is wrong, Doc knows best how to fix it – or does he?

Where a psychiatrist draws the line between an emotional crisis and mental illness is up to his personal judgment. If you wonder why prescribers don’t simply test their patients for mental illness just to make sure they really need medication, the answer makes the psychiatric discipline appear in a rather unfavorable light. There are no tests. Not medical tests, in any case. No blood tests and no brain scan can reveal mental illness. Psychiatrists have no choice but to take at face value what the patient discloses about their state. In a clinical setting, doctors can also recur to observing patient’s behavior, but even that can be interpreted in many different ways. Apart from that, it is usually nurses or other clinic staff who deal with patients more directly and more often than the prescribing doctor, who therefore works with a lot of second-hand information. Then, there are the psychometric tests. Patients may be presented with a questionnaire, for example. Now, questionnaires are statistical tools, but they are no means of exact measurement. If you have someone do the same test twice, they are likely to give slightly different answers the second time – especially if the list of questions is long and graded answers are possible. Also, what does answering “no” to questions like “Do you enjoy social gatherings?” mean in psychiatric terms? Do you suffer from social anxiety or are you just not a party animal? And finally, what if a patient, out of shame or whichever other motivation, gives inaccurate answers? Again, questionnaires are a fine statistical tool, but they are not equivalent to a medical exam. Yet, this is what psychiatrists base their diagnosis on: personal accounts given by the patient, psychometric tests, observations of clinical staff or significant others. At the end of the day, the psychiatrist has to patch all these puzzle pieces together and try to match the resulting impression to one or the other mental pathology in the ever-changing DSM.

Just for laughs here: I got tested with those famous ink blotch cards by a psychologist when I was in my psychotic break. Her conclusion: I was “too creative”, because apparently my perceptions were not classical enough for her. Where other people would have seen an evil moth, I made out two dancing African ladies. When I remarked that I had a couple of degrees in arts and that it was therefore my job to be creative, she just said: “No, no, even as an artist you still need to be adapted.” In other words, I failed to be crazy in a normal way… Woman, I was immersed in psychosis and all you found wrong with me was my creativity??? No further comment.

So, a significant number of psychiatric diagnoses are given to people who are fundamentally healthy, but who are seeking medical help because they are naturally – and necessarily – struggling to overcome a personal crisis. Few psychiatrists will remind them emotions are our connection with reality, be they positive or negative. Instead, both prescribers and the pharmaceutical industry have a political and economic interest in making you forget that humans need grief, need sadness and need anger. In fact, it is questionable whether the feelings we call negative deserve such a bad reputation. After all, they warn us when things are going wrong, when we need a change, when we are in danger, when we need to take a break from our daily grind. Can it ever be healthy to suppress these signals? Wouldn’t it be better to acknowledge them and discover their source? Is conflict solving not the natural way of reestablishing balance and well-being in our lives? If you choose to numb your instincts with drugs, you may temporarily escape the discomfort of facing your problem, but you will also steer further and further into it without even noticing. What would be healthier: worrying about a difficult curve ahead or blissfully driving off the cliff? Not everything in life is made of pink cotton candy – it was never meant to be.

Then why are people so anxious about being “normal”? Whoever defined what normalcy actually is? Well, just look around you. Mass media bombard us with consumerist utopias 24/7. Wherever you turn, beautiful men and women with impressive careers live in stylish homes, throw hip parties, enjoy perfect health and, most importantly, have found the laundry detergent that makes all this possible. Tragically, the pharmaceutical industry has joined this very profitable ride. Feel imperfect in any way? Feel troubled, fearful or sad sometimes? Or have you simply not learned how to be happy? No problem, help is nigh. We won’t teach you how to resolve those issues, but we have a pill that can make you forget you have them. If your life is a mess, just sweep all that emotional clutter under the carpet and your existence will look as if it were perfect.

Psychiatric medications are made for halting acute, disabling crisis, and nothing less than that. They are not dietary supplements you can just take on a daily basis to supposedly optimize your performance in everyday life. Yet, that is how they are being marketed. In countries like the USA and New Zealand, psychiatric drugs can be advertised on TV, along with cars, shampoos and what have you. Those commercials make it look as if mental illness were as minor a thing as the occasional headache or dandruff. People are made to believe they can just try any psychiatric drug and see if it helps them get along better with their boss or feel less stressed out by the tornado of over-sugared brats who obliterate their homes every day. In fact, many prescriptions nowadays are issued to patients who demand a specific drug they know from an advertisement. Way too often, prescribers comply without much ado. After all, the waiting room is crowded with people and every minute saved on one patient equals money earned on the next one.

Mental illness has become a booming market. No doubt should we be grateful for the many life-improving medications we have at our disposal, including psychiatric drugs. But just where does care end and exploitation begin? How is a consumer to distinguish between information and marketing? What means does one have to confirm the prescriber’s diagnosis unequivocally? Few medical disciplines are as double-faced as psychiatry is at the moment. Try convincing a non-diabetic of injecting themselves with insulin, and try making someone believe their life could be even better if they took psychiatric drugs. While the first is virtually impossible, the latter is easy. It is what happens many times over, every day, all over the planet.

It would be futile to wait for the health industry to change. As long as consumers believe medicine is always altruistic and trustworthy, they will be vulnerable to manipulation. Medicine, and psychiatry, SHOULD have a humanitarian mission rather than being a cutthroat business. But not all health care professionals and pharmaceutical companies want to know about that. However, the situation is not hopeless. You as a consumer and potential target sit at one end of the lever. You can ask questions and have a right to utter your skepticism. If you are unsure whether you need a prescription for psychiatric medication or not, the following actions can help you obtain a clearer vision of things:

  • Go for a second or even third opinion from another doctor.
  • Have a general medical checkup. Nutritional deficiencies, allergies, a damaged liver or thyroid dysfunction may be causing your symptoms. Also, have a neurological exam in order to rule out anomalies in your brain structure.
  • Take a critical look at your lifestyle and habits. Are you getting enough sleep, and if not, why (do you ingest a lot of caffeine, do you have sleep apnea, is your bedroom not dark or quiet enough, etc.)? Are you consuming any recreational drugs (including alcohol)? Are you getting enough movement and fresh air? Do you eat well? Are you regularly exposed to toxic substances?
  • What is going on in your private and professional life? Which stressors can you change or at least shield yourself from?
  • Are you carrying around an old childhood trauma or other painful experiences? These have to be worked on!
  • What is your universe made up of? Is life cold and empty to you? Find things to fill in those existential gaps. I am not necessarily talking religion here. I mean bring something into your life to help you appreciate your existence.
  • If you have a prescription, evaluate if taking the drug is worth the risk. If its negative effects outweigh the damage you are suffering from your perceived problem, refrain from using it.
  • Talk to a psychotherapist or counselor. Maybe your problems can be solved through therapy rather than drugs. If you are a believer, you can also consult with a spiritual guide.
  • Ask close friends, relatives or other people you trust how they perceive you. Their perspective may vary greatly – and in your favor – from your self-perception. Don’t be shy to accept their support and their love. Those are invaluable gifts.
  • Read, read, read. Remember: knowledge is power.

Having gathered enough information, make an educated choice. Whether you wish to try psychiatric medications or whether you prefer doing without them, both of them are valid ways, and for both you deserve respect and support. There is no shame and no guilt about any of the two. All is about building a life you’re able to love. Pick the best help you can find to get there.

The following are links you can learn more from.

Webpages:

MindFreedom is a website defending human rights in the mental health system. On this page, you can find links to various articles on doubtful marketing strategies for psychiatric medications. http://www.mindfreedom.org/kb/psych-drug-corp

Articles:

“Inappropiate Prescribing”: Article for the American Psychological Association (APA) by Brendan L. Smith, in English. http://www.apa.org/monitor/2012/06/prescribing.aspx

“The Psychiatric Drug Crisis”: Article for The New Yorker by Gary Greenberg, in English. http://www.newyorker.com/online/blogs/elements/2013/09/psychiatry-prozac-ssri-mental-health-theory-discredited.html

“Drug Companies Just Say ‘No’ to Psychiatric Drugs”: Article in English for Psychology Today, written by Pulitzer Prize nominee Robert Whitaker. http://www.psychologytoday.com/blog/mad-in-america/201106/drug-companies-just-say-no-psych-drugs

Audiovisuals:

“The Marketing of Madness” is a documentary on the marketing strategies employed by the pharmaceutical industry and the prescription of psychotropic drugs to patients who would not have really needed them. A must watch, available in English language on YouTube. http://youtu.be/IgCpa1RlSdQ

“The DSM – Psychiatry’s Deadliest Scam”, in English language, documents the shortcomings in the edition of the DSM, and how the manual impacts the entire psychiatric discipline, thereby affecting thousands of lives – not always for the better. http://youtu.be/PcuhhJ1BaMk

“How to Read Your Body”, by Dr. Eric Berg, gives simple guidelines on how to assess your overall health, in order to help you and your doctor pinpoint any underlying problems. http://youtu.be/VaUAe-csKjY.

Another video by the same author is “The Ultimate Stress Lowering Technique”. Apart from proposing stress reduction exercises, Dr. Berg also taps into the subject of inaccurate psychiatric diagnoses in stressed individuals. http://youtu.be/lsoYk5rioyw