Some time ago, I wrote about generic medications. I explained that generic medications are bioequivalent to brand name medications within a given margin. Generic medications may use binding and other inactive agents that are different from the brand name medication. All of this can lead to a generic being less effective than the brand name drug in a small percentage of cases. Usually though, the generic works just fine for people and the switch is unnoticeable. And all that information was correct. But new information has arisen. And it’s alarming information to me. It’s information on exactly how bioequivalence is determined for medication and in the case of one generic medication, the generic of Wellbutrin XL 300 mg, it caused an ineffective drug to be allowed on the market for many years.

Just to be clear, I’m not the biggest fan of drug companies. I’ve written about how much I dislike them and I’ve written about how wrong it is when they break the law and I’ve written about how ridiculous the penalties are when they do. I understand why people are outraged at companies that produce a healthcare product and then don’t follow the rules designed to protect of the health of the consumers that take it. But that aside, people seem to be really mad that pharmaceutical companies put profits before people. And my point is, so what?

If there’s one thing to remember about psychiatric (psych) meds it’s that you need to take them and you need to take them on time. This is because medication puts chemicals into your bloodstream and in order to keep a consistent level of these chemicals in your bloodstream, you must take the drug as prescribed. This is particularly critical in bipolar disorder as it’s easy to become unstable with an uneven level of psych med in your blood. But we’re all human. We all mess up and forget things and we all miss a dose from time to time. So how do you handle missing a dose of a psych med?

In spite of what some people would have you believe, I’m not actually the biggest fan of pharmaceutical companies. None of them are champions in my book. These companies only care about one thing – making money. And they will do whatever they think they can get away with to make that happen. Now, that doesn’t mean that I don’t need and use their products, because I do, but I harbour no false illusions about who it is I’m in bed with. And while I do believe that pharmaceutical companies have cleaned up their act a lot in terms of incentivising prescriptions of medication and I think doctors have done a lot to reject drug company incentives, let’s face it, drug companies will still market any way they can because that’s their job – to sell product. And when drug companies step out of line, illegally market their drugs and fail to report proper safety data, I want their hand slapped – hard. And $3 billion dollars just isn’t going to do it.

I remember, before trying medication, I was terrified of it. I had the same misconceptions that many people do: Medication is for weak people Antidepressants are just “happy drugs” designed for people who can’t handle life Medication will ruin your brain Doctors give out antidepressants like candy whether you need them or not As it turns out, none of these things are true, but they sure seemed true at the time. So I get fear of antidepressants and other medication. Psych medication is scary stuff. But sometimes you have to face that fear in order to get better.

Have you heard of the e-patient? If not, it’s OK, I hadn’t heard of them up until about a year ago either. And quite frankly, once I did hear the term, no one really explained it to me so I figured it was an “electronic” patient – maybe one who walked around with their health records on a USB stick, or maybe a cyborg patient (in which case, I qualify). Well, it turns out that there aren’t a lot of cyborg patients and while an e-patient might walk around with their medical records, “e-patient” actually refers to patients who are equipped, enabled, empowered and engaged. And, depending on whom you ask, also educated, expressive, expert and electronic. That’s a lot of stuff. And quite frankly, way too much pressure, so let’s boil it down – an e-patient is one who’s engaged with their own healthcare, and ideally, we all should be one.

Recently, I was talking with someone on Twitter and she was concerned about the side effects of psychiatric medication X. I asked her what her starting dose was for the psych medication and she said 15 mg. Now, I’m not a doctor, but I can tell you two things: That is ridiculous. That will certainly make the patient stop the medication early due to side effects and never even find out if it works.

On Twitter a follower asked me about a specific side effect of a medication. She was considering taking the medication and was worried she might suffer from this side effect. This is a reasonable concern and it’s good that she’s researching the drug's effects and possible problems ahead of time. But the thing is, while knowing about the possibilities is good, worrying about the possibilities is pretty useless. You won’t know if you will get the side effect unless you actually try the drug. The only way to know what is going to happen is to roll the dice.

Last week we talked about five of the top things that we learned about mental illness last year: Statistics on Prevalence of Bipolar Disorder How often is Bipolar Diagnosis Mistaken for Depression? Predictor of Bipolar Treatment Success Antimanic Treatment Efficacy - Drugs Compared Are Two Antidepressants Better Than One? Today we will discuss 6-10 in part two of this article.

As most people know, when a drug is developed, the drug manufacturer receives a patent on that drug. The patent means no one else may produce that drug for a period of time. Drug patents in the US are 20 years, but these patents begin before clinical testing, so really, the drug manufacturer has about 7-12 years of patent protection once the drug is on the market. After the patent expires, other companies may produce the drug, these are called generics. Do you really need to pay the high price for brand name Prozac or is the generic, fluoxetine, just as good?