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Generic drugs' hidden downside

December 17, 2007|Naomi Wax | Naomi Wax is a New York-based journalist and the editor of

IT'S A DRAG when you suffer from depression. And it's really a drag when the medication you've been treating your depression with effectively for years suddenly leaves you feeling anxious, nauseated or even suicidal. Even more of a drag? When you realize those symptoms began when you switched from your brand-name antidepressant to its generic version. But it's downright depressing when

your doctor, pharmacist and health insurance provider insist that you're wrong, that there is no difference between brand-name drugs and their generics, and that these side effects you're experiencing must be in your head. You are, after all, "mentally ill."

Yet the true insanity lies in the way many medical professionals, convinced by the FDA, keep pushing the myth that "generic drugs are identical to their brand-name counterparts." Assurances of total sameness "in dosage form, safety, strength, route of administration, quality, performance and intended use" pop up all over the FDA's website and are dutifully reprinted on the sites of health insurers, drug makers, pharmacies and others whose interests it serves.

Health insurers, for instance, save so much on generics that a number of them actually offer incentives to doctors and pharmacists to switch their patients off brand-name drugs; earlier this year, Blue Care Network of Michigan was paying $100 per case. Even more widespread: insurers' practice of charging lower co-pays for generics. Many insurers won't cover brand-name drugs at all if there's a generic available. To be sure, consumers benefit financially as well. With an average price of $102 to fill a brand-name prescription -- compared to $29 for a generic one -- generic drugs make medication vastly more affordable.

But how advantageous is it to save $70 a month if taking a generic makes you feel like crap?

I wrestled with this question a few months ago when my doctor prescribed Sertraline, a Zoloft generic, to treat my depression. I'd done well on Zoloft in the past and had seemed to do all right when I was switched to a generic, but I'd only taken it for a few months before I went off the medication entirely. This time, after a month, Sertraline hadn't made a dent in my symptoms. My generics-happy insurer wouldn't cover Zoloft, so I contemplated paying the additional cost myself. And I did some research.

It turns out that hundreds of former Wellbutrin XL 300 users were facing a similar dilemma -- although under far graver conditions. The FDA-approved generic, Budeprion XL 300, had arrived on the market last December, and in the weeks and months that followed, complaints began to appear all over Internet health boards. Users who'd been successfully treated with Wellbutrin for years said that they'd been switched to Budeprion by their doctor or pharmacist, often without being informed, and had suffered such consequences as a return of depression (sometimes more severe than ever), suicidal thoughts, panic attacks, mood swings, anxiety, nausea and insomnia. Those who then went back on the brand-name medication reported that their symptoms disappeared.

Veteran syndicated health columnists Joe Graedon, who holds a master's degree in pharmacology, and his wife, Terry, who earned her doctorate in medical anthropology, were so alarmed by the unprecedented volume of reader response on their website,, that they notified the FDA. The FDA, in October, confirmed that it was investigating but has yet to issue a comment or findings.

The Graedons also contacted, an independent testing organization. Budeprion users probably found bittersweet consolation in the lab's analysis of the little yellow pills. It discovered that "generic bupropion XL released its ingredient at a very different rate than Wellbutrin XL." While the extended-release feature is meant to keep a steady supply of medication flowing to the bloodstream throughout the day, the generic pill released 34% of its ingredients in the first two hours, compared to the brand-name's 8%. Although both pills started out with equal amounts of active ingredient (bupropion), according to the ConsumerLab report, the large upfront dose from the generic could account for the anxiety, irritability and nausea -- all known side effects of too high a dose of bupropion.

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