Generic & Brand Name Meds
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Q:  Generic & Brand Name Meds

Some background first and then the questions:

I have been diagnosed BPII after more than a year of insufficient treatment for severe depression.  If I have anything like euphoric mania it so subtle as to escape notice (dang it!).  I was, however, having extreme insomnia and had gotten to the point where I couldn't read, let alone write-- which is my profession--because my mind was spinning and leaping at such a rate that everything was a confused buzz.  A new pdoc interpreted this as a version of mania.  She weaned me off antidepressants (mostly) while easing me onto mood stablizers, with spectacular results.  I'm now on Lamictal (200mg/day), Wellbutrin SR (100mg in a.m., 100mg mid-day), and Eskalith CR (I've just started this and am at 450mg/day so far). 

The problem is that my finances have reached a state of desperation.  I have recently found a new job, but it doesn't pay well and I still suffer that special American hell of unattainable health insurance.  I've done everything I can to tighten my budget, eliminate expenses, sell possessions, etc., etc. (though, no, I haven't resorted to strip-dancing or selling organs). The best way I see to hang on with my treatment at this point is to buy generic drugs.  I can get all my meds overseas, where all are available as generics. The savings are astounding.  But how do I know when it is wise and when foolish to save money this way?  Side effects have been a big problem for me.  Are the generics (all?) more likely to have side effects?  Are they as effective as the brand names?  Can I switch from Wellbutrin SR to a generic without the sustained release? (Wellbutrin made my heart pound before I adjusted.)  If not, can I save by splitting pills?  I have heard that sustained release  tablets lose their effectiveness after being split.  Is there any way to split capsules? (Generics often come only in capsules.)  What are the differences among all the forms of lithium, and why take the CR versions when the others are so much cheaper? What's wrong with plain old generic lithium carbonate (and how does it differ from lithium citrate)?   I'm willing to put up with a lot of side effects to keep on sleeping and working -- though my particular hurdle would be the weight gain (so far not a problem).  How to pick and choose?  I've got to do this, but it took a long, long time to get from suicidal and hopeless to feeling that life is good again. I don't want to lose ground in the process of experimenting, but nor do I want to crash again because I can't afford my meds.  

P.S.  I would/will ask my doc these questions, but I'd have to pay her for her


Dear L' -- 
In the name of furthering your writing career (by saving your money to allow for more writing time), here's a free answer.  I hope its value is not commensurate with its cost! 

You've probably figured out that there's now a generic slow-release Wellbutrin (written like "bupropion extended release tablets").  I do think the SR is very different in bipolar disorder, definitely better.  It's been enough better I haven't found myself needing to cut the tablets, as I used to do with the immediate release (IR) to get the dose low enough so that it was not too activating; rather, people seem to be able to use even 100 mg SR without that effect, so I've never tried to go for "50 mg SR" by cutting them.  You could start by assuming that this generic is equivalent to the previous trade-name version, though I had one patient switch from trade name Serzone to the generic nefazodone and it was crystal-clear not equivalent, by his reaction, so if something happened after the switch, it could be a non-equivalence.  Similar stories have been reported for Clozaril and generic clozapine. 

As for lithium, you're right, plain old generic immediate release lithium carbonate is good stuff.  The slow-release approach, which you may also know was recently released as a generic also, adds just a little improvement in tolerability compared to the IR version (less tremor, especially; that's the problem I use it to solve, or at least to try to improve).  

Then there's lamotrigine.  Have you found a generic for this, overseas or somewhere?  If so, please let me know.  It's one of my favorite medications but cost factors often become limiting.  If you qualify, here's the "" page for lamotrigine (read closely, it's on there) where you might be able to get it free.  

Write on -- ooh, pardon that one.  

Dr. P'

Published October, 2004


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