Topic: Any Experience w/Generic Lexapro?

Forum: Mental Health: Because Cancer Doesn't Just Affect Your Breasts — Meet and support others who are affected by these issues around anxiety, depression & other emotional effects.

Posted on: Feb 21, 2009 08:41PM

Posted on: Feb 21, 2009 08:41PM

car wrote:

My onc has me on a Lexapro/Klonopin cocktail for perimenopausal cognitive problems, insomnia, as well as just the general stress of my cancer treatments. So far, it's worked well. I've done fine w/the generic for Klonopin. My insurance company today--out of pure altruism, I'm sure--sent me a letter telling me that Lexapro now is available in a generic form. Has anyone out there tried it? Any opinions?

I have taken Celexa (hated it) and was on Wellbutrin for a while, and did notice a difference w/the generic. I'm cautious w/generics when it comes to neurotransmitter regulation. Any feedback would be appreciated (there's a $45/mo. difference in the copay).

Unilateral mx 1/17/07, exchange 6/4/07, DIEP 4/25/08 Dx 8/8/2006, DCIS, 3cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+
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Feb 22, 2009 07:28AM leaf wrote:

Generics (in the US) need to meet the same physical requirements as brand.  For example, they have to dissolve at the same rate, etc.In the US, generic companies are not required to do studies on the efficacy of the drug because they were already done on the brand drug.

There are a few brands (maybe less than 30) where brand really can make a difference- for example oral Dilantin (phenytoin) , digoxin, etc.  For some drugs, a 'generic' drug is made by major pharmaceutical company that makes 'brand' drugs as well.

But, there are some patients that can do better on brand than generic.  Here is a study on a different SSRI (citalopram) where 20 patients did do worse on generic.  I cannot find in this abstract how many total patients did do as well on generic as brand, but it is almost certainly more than 20. www.ncbi.nlm.nih.gov/pubmed/17...

So a MINORITY of people may do better on brand than on generic.

Effectiveness in depression treatment is very difficult to study for many reasons- there aren't objective symptoms, and because there is a LARGE placebo effect with major depression, etc. (This abstract is from Pfizer, a major pharmaceutical company!!) www.ncbi.nlm.nih.gov/pubmed/19...

So no one can say whether YOU will do better on generic than brand.   I assume you can try generic and see how you feel, and switch back if you find it doesn't work well for you.

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 22, 2009 10:59AM mzmiller99 wrote:

leaf - I'm so glad you posted this!  It's not my imagination then!  I know I've done better on some brand name drugs than the generic, even though, I'm told they are the same!! 

Some of my arthritis and antidepressive meds started out as brand names and then were switched to generics and I know there was a difference. 

 Right now, for instance, the Ambien CR works way better than the generic, but I can only get 12 tabs for $40, once a month, and then only after going through a crap-load of paper work.  Obviously, I switched to the generic, but without nearly the success. 

Susan IMRT 09/08, Oncotype DX 15, Aromasin 03/09 Dx 6/16/2008, IDC, <1cm, Stage I, Grade 3, 0/1 nodes, ER+/PR+, HER2-
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Feb 22, 2009 12:26PM - edited Feb 22, 2009 12:53PM by leaf

Well, lack of sleep is 'in your head' Smile; we assume sleep is controlled by your brain. But you can't separate mind and body. 

Generics have the same chemical compound, in the same dosage, etc. as the brand.  It can have different inert ingredients.  But there are inherently many unknowns, particularly in things as difficult to quantify as psych issues. 

Some patients when they come in the hospital insist they are allergic to 'brand drugs'.  That is not possible, at least because they cannot have taken all drugs, or all generic drugs.

It was not a 'double blind placebo controlled study' in the study cited above.  Using a brand over a generic  may be a 'placebo effect'.  IF something has a placebo effect does not mean it isn't 'real'.  It sounds like in this study the 20 persons did do better on brand than generic.  

Pain and pain treatment, which obviously are very real,includes a big placebo effect.

At my hospital, with the exception of the few drugs mentioned ( i.e. Dilantin, digoxin, etc the brand drugs in question have objective endpoints) - if the patient insists on brand, they need to bring in their own. 

I'd love to learn more about 'placebo effect'.  

I take sertraline for my PTSD.  I don't know if it has a placebo effect for me or not.  But I don't really care about how it works.  It may not be working at all.  But I do know my PTSD symptoms are better than they were a year ago.

All medications involve balancing the risk vs the benefit.

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 22, 2009 01:09PM - edited Feb 22, 2009 01:26PM by car

Thanks, I really appreciate this. I might try it after I check w/my onc and search Medline myself (thanks for the links). At least my insurance company is giving me the option of trying it for 6 months for free. I may go on a month-to-month basis and give it a try. I've got plenty of the brand here if I need to go back on.

I do know that I did better on brand Wellbutrin and have read studies that indicate that some pts. have claimed it isn't as effective. My sister's partner had a similar problem w/an SSRI the name of which I don't recall.

Sorry about the length--I've been thinking more about this. They taught us in grad school that any intervention or drug can have a placebo effect of up to 30%. That's why the best studies are double-blind placebo trials. That is, neither the research assts. nor participants know if they're getting a placebo or an actual drug since expectancies are related to the placebo effect. 

On the other hand, I've started buying brand OTC drugs due to concerns about QA and where products are manufactured. I don't know if this is overkill and a waste of money, but I'd like to know who manufactures my medication and where. A lot of this is due to the media attention given lately to poor QA and recalls, so this might be overkill as I say. 

Unilateral mx 1/17/07, exchange 6/4/07, DIEP 4/25/08 Dx 8/8/2006, DCIS, 3cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+
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Feb 22, 2009 07:15PM PhyllisCC wrote:

Lipitor is one drug my company wants me to NOT to get.  But with all side effects you can get... and from what I've read there really isn't a generic for it.... I'll pay the increase co-pay. 

Ambien CR's generic Zolpidem (?) works well for me and the cost is a lot less.  My dh is on Sertraline...and it works as good as the name brand.   But he is staying on Lipitor too. I checked with my doc...sometimes he is okay with generics.  But he, too, says the Lipitor is working great for us.. so we stay on it.  We finally found one that really works for both of us so for right now we're staying on the name brand. - Sorry off-topic.  Phyllis

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Feb 22, 2009 08:09PM leaf wrote:

Here's some interesting findings about placebos in depression from UCLA.

Our group is the first to report that when treatment with placebo reduces symptoms, it also changes the function of the brain. We examined research subjects with major depression, some of whom respond favorably to placebo treatment as part of research studies. When the subjects improved during placebo treatment, their brain function changed; the changes seen during placebo treatment were different from those seen during medication treatment. You can read the press release here and the full article was published online in January 2002 in the American Journal of Psychiatry. This work was replicated and extended in our December 2004 publication in Psychopharmacology.

More recently, we have reported that brain function changes during a brief placebo treatment period can identify those who will later develop side effects when taking a real antidepressant medication. The press release and article from the April 2005 issue of Neuropsychopharmacology are both online.http://www.placebo.ucla.edu/

Classic LCIS.If knowledge can create problems, it is not through ignorance that we can solve them- Isaac Asimov Dx 12/8/2005, LCIS, ER+/PR- Surgery 1/24/2006 Lumpectomy: Left Hormonal Therapy 7/15/2006 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Feb 22, 2009 08:57PM - edited Feb 22, 2009 08:58PM by car

Thanks, Leaf. This is a help. It would make sense, too, since the medical community defines a placebo as an inert substance that has a physiological effect.

I'm tempted to try the generic for a month, because it was clear w/in a week or two that the Wellbutrin wasn't working. But, I'm also cautious about changing right now as my dog's first onc appt is Tuesday. Poor guy.

Unilateral mx 1/17/07, exchange 6/4/07, DIEP 4/25/08 Dx 8/8/2006, DCIS, 3cm, Stage 0, Grade 2, 0/4 nodes, ER+/PR+

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