I have been taking a generic form of an anti-depressant for some time now. I recently noted that every month the pill was a different shape, size, and color. In fact, I once took a pill back to the pharmacy to confirm that is was indeed the medication I was suppose to be taking. Insidiously, over the past several months, my wife noted a personality change. Although I have always been rather out-spoken and quick to react, she noticed that I was becoming increasingly hostile and verbally abusive with little or no cause. At first I just attributed it to marital strife. That was until last week. While out of town, I found myself n a new rental car in a dark airpot garage. I could not find the controls for the side view mirrors and exploded. Yelling and screaming, I rolled down a window and had a company agent locate the switch for me on the console. I thanked them but not until after slamming my door so hard, the entire car shook. At last I knew that I crossed the line of insanity.
My wife was quick to suggest the problem might be my medication as several years ago she had had a similar problem with one of her generic meds. The issues resolved after she was able to resume her brand name medication, although that took battling with the insurance company for months. So I called my physician and asked that they phone in an order for the brand name of the drug I was taking. However, before I was able to buy it, I made the decision to stop the generic abruptly. As I physician I knew the risk of doing so but at this point I did not care. I was convinced that not only was the generic not helping, but it was making the illness for which it had been prescribed worse. I had truly "lost my mind." My wife's diagnosis was correct. Within 48 hours I was much calmer and less combative.
To be sure this is not an example of a medication having a paradoxical or adverse reaction. Indeed, I had felt well.....when I was on the brand name drug. Unfortunately, the FDA does not require that generic medications meet the exact criteria of their brand name counterparts. Short of making sure that the generic form has the correct dosage and type of drug, little else is checked. Pills can be stuffed or filled with different "non-active" ingredients affecting the amount of drug "bio-available" inside the body. Lord only knows what else happens at the time of the manufacturing.
In its never-ending quest for higher profits, Big Pharma, i.e. the drug companies, sub contract out the manufacturing and or purchase of these generics to any third world nation willing to undercut each other's price. In the process, quality inevitably suffers. Each month my Medicare Part D insurance company, or pharmacy benefits managers, searches for the best price for various drugs for that month. Hence, my ever-changing pill color, size, and shape.
It is largely unknown how many patients suffer daily from this practice. To take a drug that does not dispense the exact type and amount of medication as that of the brand name is one thing. But to have it cause serious side effects is adding salt to the wound. The FDA encourages physicians to report adverse drug reactions. However, although I am a doctor, in this scenario, I am the patient and other than complaining to the pharmacy, which I plan to do today, I am powerless.
Thus, all I can say is if you are on a generic medication and something seems to be different, insist on a 30-trial of the brand name.