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The FDA sees no difference between brand-name drugs and generic medications for depression. Most psychiatrists believe the drugs are interchangeable and prescribe generics without hesitation.
Still, it’s not usual for patients to perceive a difference when they switch from one type to another. Sometimes they may feel a return of the symptoms like sadness, anxiety and helplessness. Other times, they may get a jolt of old side effects from the drug when it was originally taken. Put these minor effects to the side and Dr. Jonathan Edward Alpert, MD, PhD, says there is no systemic problem with generic antidepressants. “In general, they’ve been very good,” he says. “But doctors need to be vigilant.”
There are a few reports that show patients, when switching from brand-name to generic, experience a return of their original symptoms. Generics may be different in ways that are slight but have impact. The FDA requires that generics provide blood levels of a drug that are 80% to 125% of what the brain-name drug provides. In fact, the generic may be formulated with different non-active ingredients – the binders and outside coating – which can affect the rate at which a drug is released into the body’s system. This is how you can have several generic options for a brand-name drug. The difference lies in the binders and coatings.
“In general generics have been as effective as brand-name antidepressants. And they’re less expensive, so it makes sense to use them,” explained Alpert. “But the differences for a given individual might be enough to throw off that individual’s response or to cause additional side effects.”
“In my experience it’s a minority, but if someone says, ‘I switched to generic citalopram and went downhill,’ I’m going to pay attention. I’ll consider other factors that may have brought back the symptoms. But if the patient can afford the brand name we may switch back, or we may try some other medication. It depends on the patient.”
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