You may have heard many different names for the same antidepressant. This can be confusing. All medications have a generic name. This is the scientific name assigned to the medication in the laboratory. Pharmaceutical companies also select a trade name for their new medications. The same medication can have more than one trade name. Usually, the trade name is more recognizable than the generic name due to advertising by the pharmaceutical companies.

However, researchers usually use the generic name when they discuss the medications in lectures or scientific magazines.

Many people have heard of the antidepressant Prozac. In the 1970’s, it was the first serotonin reuptake inhibitor to be developed, by the pharmaceutical company Eli Lily. Prozac is the trade (brand) name for the generic medication, fluoxetine. (Trade but not generic names are capitalized.) Eli Lily also markets the same medication, fluoxetine, as a treatment for Premenstrual Dysphoric Disorder (PMDD), with the trade name of Seraphem. (PMDD is a condition of emotional and physical problems occurring prior to the menstrual period severe enough to impair functioning.) There is also a long- acting form of Prozac called Prozac weekly, which usually only needs to be taken once a week.

Many new medications cannot be purchased in generic form. This is because pharmaceutical companies file patents on medications that they develop so that other companies cannot copy and sell the same medication. Companies spend millions of dollars researching and developing each medication in the hope of making an even bigger profit. If other companies were allowed to copy the medication as soon as they were ready to be sold, the original company would lose a lot of money and stop inventing new medicines. Generally, a patent runs out 30 years after it is filed. Since patents are usually filed early in development, and it can take years of development before a medication is ready to go onto the market, the actual time that a medication can be sold exclusively by the original company may be considerably less than 30 years.

After the patent runs out, other companies can sell generic forms of the medication. These have the same chemical structure (active ingredients) as the original medication and therefore work the same way. However, there may be different inactive ingredients – fillers in the tablet or capsule that surround the active ingredients. Fillers don’t cause any changes to the body, but are required to give the medication its structure, and must be dissolved in order for the active ingredients to work.

The generic medications may therefore be absorbed somewhat differently from the brand name. Some generic medications are slightly less well absorbed than the brand name. Most of the time, this doesn’t make a difference. However, some brand name medications” are highly recommended. Certain brand-name anti-seizure medications are better absorbed than the generic form. This can make a difference for seizure control.

Many antidepressants are now available in generic form. Most insurance companies will not pay for the brand name medication if a generic is available, since generics tend to cost considerably less than the brand name. However, insurance may pay for brand name medication if the physician documents that it is “medically necessary.” An example of the brand name being medically necessary is when a patient has an allergic reaction to an inactive ingredient in the generic.

It takes many years from the time a medication is initially envisioned in a lab to the time it comes on the market, due to extensive testing that must be done. Most medications developed by pharmaceutical companies never actually make it to the market. They may have been found to be either not as effective or not as safe as originally believed.

A medication must go through several stages of research before it is approved for general use. During the pre-clinical phase, the medication is studied in the test tube and in animals. Following this, there are four clinical phases, in which the medication is studied in people who have volunteered to participate. During phase I, the pharmokinetics are determined- how the body handles the medication. The ways the medication is absorbed, distributed in the body, and eliminated from the body are studied. Initial safety information and appropriate dose are established. During phase II, further safety information at the ideal dose established. During phase III, the safety and effectiveness of the medication is compared to standard treatments already on the market. In order to be approved by the Food and Drug Administration (FDA) and be sold on the market, the pharmaceutical company must show that the medication has an advantage over standard treatments.

If the medication is approved by the FDA, it can be prescribed by physicians and sold to the public. Phase IV is the post-marketing phase-additional safety and effectiveness information is obtained from people who have been prescribed the medication. Sometimes, side effects don’t show up until phase IV, when large populations have been exposed to the medication. This is the disadvantage of being one of the “first on the block” to try a new medication- you risk developing a rare side effect that had been previously unknown. Usually, these initially show up as individual “case reports” that doctors report to the FDA. If a trend is found, the FDA may issue a “black box warning” or take the medication off the market altogether. Examples of rare side effects that showed up during post-marketing are liver failure with Nefazadone, an antidepressant, and closed-angle glaucoma with Topamax, an anti-seizure medication sometimes used for Bipolar Disorder.

It is important to report a bad reaction to a medication. The physician who prescribed this information must know about it in order to make appropriate changes. If this a serious or unusual reaction, it is also important for the FDA to know about it so they can investigate further or take action with the manufacturer. Ideally, it is the prescribing physicians who reports this to the FDA, since they can supply the technical information. Patients or family members who wish to report directly to the FDA can obtain directions and forms from the FDA website (It is important to notify the FDA if both the physician and patient are reporting to clarify that both reports are about the same person.)

Giving disproportionate publicity to medication side effects is doing the public a disservice.

People who may have been helped by the medications may be reluctant to take them. An influential person who had negative experiences with psychiatric medications might tell reporters, “Psychiatric medications are terrible- don’t ever take them.” A person who spends a lot of time on the Internet might write on multiple chat sites, “Don’t ever take medication X- it did terrible things to me.” This frightens people and prevents them from trying medications that could have a lot of benefit.

For example, I once had a bad reaction to an antibiotic I was taking for an infection. I broke out in an itchy, uncomfortable rash from head to toe. It turned out that I had a serious allergic reaction to this medication. I had to go to my doctor right away, stop the antibiotic, and take a different sedating medication to fight the rash.

Do I use my sphere of influence as a physician to tell my patients, “Don’t use antibiotics- they can give you dangerous itchy rashes?” No, that would be irresponsible. Although this antibiotic was harmful to me, it helps many people, and only a small percentage of the population is allergic to it. It should be prescribed to people to whom it is appropriate.