Sorry what? Generic ADHD drugs vs. brand name

I recently went to refill my ADHD prescription, only to discover that the generic version of my medication was available. Huzzah! I have long lamented with how obscene the costs of brand name medications are, and that many people can not access the medication that for me, in a word, has been life changing. I’m lucky enough to have a partner that has good benefits, and so it was accessible for me.

I merrily brought the new generic ADHD drugs home, at the same dosage rate, and proceeded to start taking it the next day. And the next. And started to notice differences. I was really moody by the end of the day, was exhausted, and couldn’t focus well at all. I was bouncing all over the place, and generally felt like crawling out of my skin. My mental health really suffered, and I started to experience thoughts that were akin to what led up to a past severe depressive episode.

I had to be crazy, right? This was the same medication, at the same dosage.

That is where it gets tricky.

I can only speak to Canada, but here are some facts I found on the CDA website:

• One of the key parameters for bioequivalence is the area under the curve (AUC). The AUC is a mathematical calculation based on a graph of blood concentration versus time, and it correlates well with total drug exposure.

• The AUC of a generic formulation must be no less than 80% or no more than 125% of the brand name formulation. There is international consensus that differences within this range are not clinically significant.

• More importantly, the 90% confidence interval of the AUC must also fall within 80% to 125%. Recall that the confidence interval is a range of measurements within which we can be confident that the true result lies.

Okay. So maybe I’m part of that 5% variance that the generic drug doesn’t work as well for. Even if it was statistically working at 80% effectiveness, to me it felt like 30%. Regardless, I had to bite the bullet and buy the brand name, just to stabilise myself. My doctor since confirmed that generic drugs can be less effective, and wrote "Do not substitute" on the prescription.

I don’t know where I’ll go from here, but the exorbitant amount I’m now paying for medication is not sustainable. Even at almost double the dosage, the generic was ineffective for me, compared to the brand name.

That said, I am immensely grateful that there is now a more affordable option available, especially for those who were priced out of the brand name meds. I know how well I function without them…. terribly.

Have you switched from brand name to generic? Any adverse experiences?

Some articles I read:

• Bioequivalence and Interchangeability of Generic Drugs (Merck Consumer)

• Generic vs. Brand-Name Drugs: What’s the Difference? (Cedars-Sinai)

• Do generic drugs compromise on quality? (Harvard Medical School)