Posted by colin wallace on March 5, 2002, at 8:46:15
I personally find a marked difference in my reactions to brand Prozac and its generic equivalent.This idea was scorned by my (ex) psych., and I began to question my own judgement.Having reacted dreadfully to a UK generic,(and previously having reacted well to the original) I have only recently (two years later) returned to a trial of the Eli Lilly Prozac.I have had none of the anxious agitaion that accompanied the generic trial, and feel some improvement after only one week.I quickly slid downhill on the generic, and I must say that they 'feel' as different to me as effexor and lofepramine!
I this possible, I ask myself? Or is it just a personal quirk due to some abnormal sensitivity of mine? This article answered my question, and left me feeling vindicated (and a little angry at being disbelieved):1 The Ottawa Psychopharmacology Clinic, 1929 Russell Road #329, Ottawa, Ontario, Canada, K1G 1P5
2 Institute of Mental Health Research, Ottawa, Ontario, Canada
3 Ottawa Hospital, Ottawa, Ontario, Canada
4 Royal Ottawa Hospital, Ottawa, Ontario, CanadaClinical experience suggests that there are differences in efficacy and adverse events between generic and brand versions of antidepressants. This study attempted to objectively evaluate whether there are significant differences between generic and brand fluoxetine before and after a medication crossover. Forty outpatients meeting DSM-IV criteria for major depressive disorder participated in this 6 month randomized, double-blind study. After giving full and informed consent and meeting enrollment criteria, treatment with either Prozac or Novo-fluoxetine was started. Initial daily doses were 20mg, with the option after week 5 of altering the dose as needed. At week 12 patients were switched to the alternate fluoxetine type, maintaining dosage level. At each weekly or biweekly visit efficacy measures were taken (Hamilton Depression Rating Scale - HAMD, Montgomery-Asberg Depression Rating Scale, Clinical Global Impressions, Hamilton Anxiety Rating Scale, and Hopkins Symptom Checklist), adverse events were assessed, and vital signs and concomitant medications were recorded.
Results indicate that the two types of fluoxetine are clinically different in some respects. The generic fluoxetine was more likely to cause anxiety/nervousness and diarrhea (UKU) at week 12 as compared to the brand fluoxetine. Although no significant differences between the two types of fluoxetine were found at week 12 for the HAMD-17 item scale, differences between the two groups were found for the HAMD-6 item scale (depressed mood, guilt, work and activities, retardation, psychic anxiety, and general somatic symptoms), with patients taking brand fluoxetine rating as more improved on the HAMD6 scale as compared to patients taking generic fluoxetine. The fluoxetine-type crossover did not cause any significant changes in efficacy or adverse events, although the long-half life of fluoxetine may have limited the opportunity to detect differences. These results confirm the ability of the HAMD6 scale to measure change in efficacy, and indicate that bioequivalence does not always equate with clinical equivalence.
Funded by the Psychopharmacology Unit and the Associates in Psychiatry of the Royal Ottawa Hospital. All work was conducted while D. Bakish was Head of the Psychopharmacology Unit of the Royal Ottawa Hospital.
poster:colin wallace
thread:96481
URL: http://www.dr-bob.org/babble/20020301/msgs/96481.html