|
samboct -> RE: Generic Antidepressants (11/15/2010 7:18:54 AM)
|
A few comments here-
1) Serotonin is a chemical in the brain that has a wide variety of effects. The reason it was chosen as a target was because the concentrations were high enough to measure. It's highly unlikely that getting the serotonin levels "correct" will actually cure depression- the compound just has too many effects. There's no evidence that serotonin controls only depression.
2) Pharmaceutical firms and insurance companies exploited the lack of unity and theoretical development in the psychiatric community to replace talk therapy with various pills. The idea that "bad brain chemistry" has to be treated with pills is nonsense. There are a number of brain illnesses that respond well to talk therapy without the pernicious side effects of weight gain, lack of alertness, or other organ effects. Also- fMRI studies have shown that talk therapy has the ability to alter brain chemistry- although the alteration is different from a chemical compound. If well done, talk therapy may actually provide a "cure"- rather than a temporary fix. While this would be good news for insurance companies, it's bad news for pharma. Also- insurance companies did not understand talk therapy and were not presented with good business models- so they went with the pharma option. Most insurance plans are very intrusive and offer too little coverage to really cure the disease, but YMMV.
3) Like many pharmaceutical treatments, often anti depression meds act on a symptom, rather than the root cause of the disease. The disease is smart and adaptive, and figures out a different pathway- hence the meds often become ineffective over time. There have been a number of studies that have shown that talk therapy can be more effective than meds- or that meds without talk therapy give the poorest results. Some people do respond well to a combination, but depression is an illness that we don't have good long terms chemical treatments for. I suspect that there are a lot of similarities in between cancer mechanisms and depression mechanisms- not the exact pathways of course- but the adaptive nature of the diseases.
4) I have an aversion to meds prescribed for what should be normal human behaviors. That so many people are on sleeping meds is indicative of a wide spread problem in our society- its not healthy. And people shouldn't be on sleeping meds long term- generally they lose effectiveness over time and require higher doses. Also- it can be really tough to wean yourself off of the damn things. I know this first hand.....
"The active ingredients in ALL generic drugs are IDENTICAL to the brand names. It is the inert ingredients that are changed by varying (always miniscule) amounts. Other than that, the dosing can sometimes change. By that I mean where the Brand may come in 5mg, 10mg, etc. The generic may also offer 7.5mg and 12mg."
Sorry- but this is wrong. Branded pharmaceuticals are often patented on both chemical structure and synthetic routes. Generic manufacturers often develop different synthetic routes to save money. In many cases, drugs are really mixtures- the separation of isomers is not complete although pharma manufacturers would like you to believe that there stuff is that pure and well characterized. Generics can have different ratios of various isomers as well as trace contaminants. We're not even getting into the quality control in the manufacturing process, where even the large pharma companies have had screw ups in processing where there was a failure and the correct compound was not synthesized.
Also- it's pretty unlikely that the small tweaks in things like binders, colorants, etc. really affect the absorption of a compound significantly. That can vary along with what you've eaten and your own digestive pathways- so the likelihood if a generic version doesn't work as well as the name brand is likely due to variations in the active ingredient.
Sorry to say- but using generics is something that probably has to be done on a case by case basis. Like all drugs, individuals reactions may vary. Also- physicians often only have a limited number of cases that they can refer to. If one of their patients has a bad reaction to a generic- that may warn them off, but if they don't prescribe the same drug to a lot of their patients, they're not likely to have a good understanding of the effects of the substitution. We do a terrible job of monitoring adverse drug events in this country- we rely far too heavily on clinical trials during the approval process. Once the drug has been approved, there's really not much tracking unless there's a lawsuit. Another one of the reasons our medical costs are so sky high in this country- the system does not work well. The reality is that we all need to be guinea pigs.....
Sam
|
|
|
|
