While the FDA doesn’t acknowledge a difference between brand-name antidepressants like Paxil and generic versions, some doctors warn that making the switch could cause a relapse in depression symptoms.
Dr. Jonathan Edward Alpert, chief of clinical psychiatry at Massachusetts General Hospital in Boston, says that there hasn’t been a “systematic problem” associated with the generic versions of antidepressants.
“In general they’ve been very good,” he says, before warning that “doctors need to be vigilant.”
Alpert is referring to the fact that sometimes patients experience a return of the old sadness, anxiety and feelings of helplessness that the name brands like Paxil helped to get rid of. Other times, the patients will get an unusual jolt of the exact same side effects from the generic versions as they got while first taking the name brand. That may be cause for patients not to make the switch to generics at all.
During one study, a group of Canadian psychiatrists mentioned seven cases where the depressed patients were taking Paxil or Celexa. When the patients switched to the generic versions, paroxetine and citalopram, the patients experienced a relapse of their depression. Some of the patients reported that they were suffering from recurrences of the side effects that they had when they switched to generics. At least one of the patients said that the depression came back after switching.
What makes the generic versions different may be what causes the symptoms. While generic versions are pretty much made with the same medicinal ingredients, there are a few differences. The FDA requires that generic drug offer blood levels of a drug that is 80 to 125 percent of the brand name version’s. However, the generic antidepressant may be made with different non-active ingredients than the name brands. These are mostly composed of the outer coating that surrounds the pills, and this can cause changes in how fast the pill gets into the system.
Of this, Dr. Alpert says, “In general, generics have been as effective as brand-name antidepressants. And they’re less expensive, so it makes sense to use them, but the differences for a given individual might be enough to throw off that individual’s response or to cause additional side effects.”
In this sense, cheaper may not necessarily be better.
