With restricted formularies and expensive “co- pays” for patented medications, people have an increasingly high stake in whether they take brand name or generic pharmaceuticals. Numerous studies on the subject of generic alternatives among medications used in treatment of mental illness, specifically the antipsychotic drugs has been conducted; yet the subject continues to generate debate.

Even though generic drugs contain the identical active element as the brand-name original, there are important differences between them. These physical and chemical differences in how the drugs are made can affect how the drug affects people—for example, exactly how the drug is made can affect how it quickly and how completely it gets absorbed into the body. In this example, that changes how long the effects of the medication last at certain doses.

In order to say that a generic drug is biologically equal to a brand-name drug, it has to pass certain guidelines. The guidelines in place allow the effective dose of the generic medication to be up to 25 percent higher or 20 percent lower than in the original brand-name drug. This variability alone can affect how well the drug works and the side effects it causes. Also, when these medications are compared, they’re often compared in volunteers who do not have mental health conditions—therefore, the amount tested is sometimes much less than the amount some people might be prescribed to treat their mental health condition. That means that people don’t necessarily know how the differences between generic and brand-name medications will affect people at the dosage levels people actually take them.

Several reports have found differences when patients were switched between brands of a specific medication. There are also many anecdotes of people experiencing less effective medication when they switch from a brand-name to a generic or between different generics.

Many patients take multiple medications, often for more than one illness. For most people, the co-pay costs of several brand-name medications can make them impossible to afford. Therefore, there’s strong pressure from patients as well as insurers to prescribe less expensive generic equivalents. Generic drugs now make up 44% of all prescription drugs sold in the United States. 

Patients and family members should be highly alert to how things go while changing from one medication to another, or when a pharmacy switches brands of generics. With every change, you need to look out for any loss of effectiveness or the appearance of (or increased intensity of) side effects. If the look of the medication has changed or if there are any negative changes, let you physician know immediately. It may be possible for your doctor to adjust the dose of medication to fix that change. But if the negative changes are severe and you cannot wait for an adjustment in dose to take effect, talk to your doctor about changing back to the previous product.

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