My apologies to Shakespeare.
Whenever one of the antidepressants goes generic, there is a small percentage of people that have a return of symptoms of anxiety or depression that had previously been in good control. When the medicine gets switched back to the brand name only, the symptoms become under control again. This, of course, feeds into the whole idea that part of the response to antidepressants is a placebo response. But I am equally sure that it comes down to an issue of quality as well. Brand name medicines are made under very strict quality controls and standards of quality. Generics, on the other hand, enjoy some latitude as to the potency of the medicine that is produced. {NOTE: the following statement might be incorrect . . . please write in if you know differently}. My understanding {please see previous sentence}, is that generics can be anywhere from 85% to 125 % of the potency of the brand name product. If I was a manufacturer, I just might aim for that 85 %. After all, it does boost profitability of the tablet by 15 %. I know that sounds very cynical, but business is business. If it was just that, I could boost the dose of a generic up and I would get the same amount of medicine to the receptors and all would be well . . . but it is typically not that easy. For some, increasing the dose does not do it. Switching back to the brand name does. Does this mean that the active ingredient in the generic product not the same as the active ingredient in the brand name? Does it come down to bioavailability based on an effect of the inert ingredients in the generic product. I don’t know. But I do believe that what my patients report to me is real.
But anyway, back to Zoloft. I heard an interesting tidbit from the Pfizer rep who was in the office the other day. As part of their financial planning as Zoloft went generic earlier this year, they purchased a “generic” company so that they could continue to manufacture sertraline and make some money off the Zoloft wave. So, if you go to your pharmacy and ask for the “Greenstone” generic, you will be getting brand name Zoloft at generic prices! Pretty neat, huh!?!
Dr. Hartman,
Since Zoloft is one of my medications I take twice daily, you can be sure I’ll ask for “Greenstone” generic from now on. But at the same time your blog gave rise to the question “Aren’t generic drugs supposed to be identical to brand name?” I am particularly concerned because all of my bipolar medications except Depacote are available in generic form and my insurance company will only pay if this is the case. Is this analogus to buying the CVS brand of a daily vitamin as opposed to Centrum? The label of the CVS brand states “identical to the ingredients of Centrum”. I check them both and they are indeed. However, there is a significant price difference as with brand name vs generic. Aren’t you supposed to get what you pay for? Is generic inferior? I will look forward to your answer.
I enjoyed reading all your blogs and found them interesting, informative, and useful. I am glad I saw your card today.
I have comments for another blog to come later.
Robert