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
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
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 "NeedyMeds.com"
page for lamotrigine
(read closely, it's on there) where you might be able to get it free.
Write on -- ooh, pardon that one.
Published October, 2004