Have you ever gotten a medication refill that... didn't work?

[Cyllya]

Hi, all.

Since late September, I've been taking 50mg Sertraline HCL (SSRI anti-depressant aka zoloft) to treat my relatively minor but cyclical depression. It's been working pretty well. I occassionally consider going up to a higher dosage, but I always decide against.

Every now and then I have a day where I feel like, "My life is horrible!  And my anti-depressants aren't working!  I need a higher dose! " ...but then I realize I forgot to take it that morning, heh.

But this is the second or third day in a row I've felt like that, even though I have been taking my medicine. It's the same dose, same frequency, everything. My depression is worse than it's ever been in my life. I had trouble sleeping last night. I randomly broke into tears last night. I had the runs on Saturday. I keep twitching/shivering(?) a lot. I've practically got "SSRI Discontinuation Syndrome!!!" tattooed all over me. Why, when I've been taking the same medicine dosage?!

Starting Saturday morning, I started taking my most recent refill of this medication, which was made by a different manufacturer (same pharmacy) than the bottles I had before. The medication is supposed to be the same even though the packaging or the pill might look different. But since it corresponded with my weird symptoms, I went and talked to the pharmacy about it. The pharmacist acted very sympathetic, but she insisted the medicine was fine. She suggested I call my doctor to get a higher dose.  What the heck, why would the medicine go from "works great, could use a higher dose" to "completely counter-effective" in the span of two days?!!

So I called my doctor and gave my spiel to the receptionist. She said I'd have to come in so that the doctor could "evaluate my symptoms." So I have to go through another day of this misery and then pay $25 to tell my doctor I'm sad. But I bet she's just going to tell me I need a higher dose. Hopefully that's just my depression-induced pessimism.

So, has anyone ever had medicine suddenly stop working when getting a refill? Is it possible I got a dud somehow, or that this different manufacturer has made some change that messes with the effectiveness? If that turns out to be the case, how do I fix this situation? (The pharmacy better refund my doctor co-pay if this turns out to be the case?) If that's not the case, what do I do?

I considered posting this in Mental Health, but even though I think that my original diagnosis of depression is relevant (because I bet the pharmacist would be more concerned if I said something like, "Ever since you change manufacturers my rash has come back worse than it's ever been!!!"), I figure it's not really anti-depressant-specific. I don't know.

[KempsMama]

I have been on several meds for bi-polar for almost ten years, and I can't say that I've ever noticed a difference when there was a change between generics.  However, I do usually need a medication adjustment this time of year.  Winter's getting long, the cold, I'm not sure what it is but I always struggle this time of year.  Also my doc likes to see me every three months, because she says that's how long it takes for your body to get used to a dosage and to determine if you need a higher or lower dose. 

HTH!

[VisionaryMom]

I've never had the problem with different generics specifically, but I have had a few doctors who have mentioned that it's a problem some people have. Unfortunately my meds usually are newer and not available in generic, so they're ridiculously expensive!

It's also possible for a medication to work for a long time and then stop working. I've had that happen with a couple of drugs.

[Thandiwe]

I have taken anti-D's on/off throughout my adulthood, mostly Zoloft, and I *have* noticed a difference between generics.  With my 2nd child PPD, I got a generic for the first time at a local supercenter, and it was NOT as powerful.  I switched back to the old pharmacy, and it was more powerful, in my opinion.  I can't answer why, but I wanted to tell you you're not crazy: it happened to me.  FWIW, it has happened to my mom with other meds too.

[KimPM]

I have no experience with antidepressants, but I can tell you for sure my thyroid medication gives me different results from different manufacturers.  I have to have the doctor write "DAW" (dispense as written) on the prescription to get the brand name (which works for me), not the generic (because none of those work right for me).  Not only that, I have an allergic reaction to the generic.  It costs me more, though, to get the brand name, even though I can't tolerate the generics.  (Don't you just love it when the pharmacy substitutes one mfr for another and doesn't tell you about it.)

Bottom line for you is, if a particular brand works for you, see if you can have your doctor write the script for the one that works for you...even if it's a specific generic manufacturer.  You may have to go through the trouble of getting a proper script, rather than arguing with the pharmacy.  They see one generic as being equivalent to another.

[Cyllya]

Thanks for the info, guys. I finally found a google phrase that gave me info on this, and it turns out I'm indeed not alone but in the minority, though most of the sites talk about switching from the brand name to a generic. Apparently generics are only required to cause 80% to 120% of the blood level of the brand name, or something like that... so different generics can be at the opposite ends of that spectrum and for sensitive people it would be like changing your dosage. Plus they aren't required to have the same inactive ingredients. 

My doctor agreed with me about what the problem was, but she didn't seem rarin' to go yell at the pharmacy for me, unfortunately. I didn't think to ask her if she could write the scrip for just that brand, but her solution (and the one I saw on the net) was just to take a higher dose... and switch pharmacies. She wrote a scrip for more pills (45 per month) so I could start taking a pill and half each day. I'm not even sure my first pharmacy could do that, since it looked like their fancy packaging was made specifically for 30 pills, all neatly labeled with the days of the week and everything.

I took 75mg today and I feel better.

It's also possible for a medication to work for a long time and then stop working. I've had that happen with a couple of drugs.

I could understand that the medication could become ineffective over time, but to suddenly give you discontinuation syndrome (withdrawal effects)?

[KMK_Mama]

A friend of mine has had that happen with her sleeping pills. She didn't sleep for a few days and then realized they were from a different company. Once she got the "right" ones, the meds went back to working fine!