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Making Adjustments With Generic Antidepressants

Gabrielle Melin, MD, a psychiatrist at the Mayo Clinic in Minnesota, agrees.

“In my experience it’s a minority, but if someone says, ‘I switched to generic citalopram and went downhill,’ I’m going to pay attention. I’ll consider other factors that may have brought back the symptoms. But if the patient can afford the brand name, we may switch back, or we may try some other medication. It depends on the patient.”

Sometimes, therapists say, it’s just a matter of adjusting the dose. The same patient who did well on 20 micrograms of Celexa might need, say, 30 or 40 milligrams of the generic citalopram to get the same effect.

So What’s the Bottom Line With Generic Antidepressants?

Psychiatrists have little data to work with when making decisions about the use of generics, largely because there is not a great deal of research on their use. The companies that make them have no interest in paying for dose-comparing clinical trials. Neither do the makers of the brand-name drugs that the generics replace, says Bradley Gaynes, MD, MPH, a psychiatrist and professor of psychiatry at the University of North Carolina, Chapel Hill.

“It’s the kind of thing that the National Institutes of Health might want to study, but they are usually interested in what’s the best new thing,” says Gaynes. “Pharmaceutical companies aren’t likely to fund a study unless they are confident their drug will do better.”

The bottom line is, in general, generic antidepressants are safe and effective. But as with any medicine, it’s important to keep track of how it affects you and discuss any concerns about it with your doctor.

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