I am very, very well medicated.
I pay an obscenely expensive concierge psychopharmacologist to help keep me, my brain, and my three drug cocktail in good working order.
If you’re wondering, I have atypical depression. Real world definition at bottom.** In layman’s terms, the hallmarks of atypical depression are being sad, eating too much, sleeping too much (and often having your limbs feel like lead), and an extreme reaction to rejection. When I get rejected in any way, or feel it coming, my mood sends me into a tailspin. I am a 4-year-old who’s lost her favorite toy, a 12-year-old whose first crush spurns her. At its worst, I am a hopeless, morose, sobbing, unhinged lunatic.
Said psychopharm and I have spent an inordinate amount of time getting my “cocktail” (Wellbutrin, a mood stabilizer, and an SSRI) into a place where I pass, he says with irony, the “cocktail party” test. Apparently, I appear mostly normal.
Six years ago this coming winter, a company named Teva introduced a generic Wellbutrin. When it came time to refill my meds that January day, my pharmacist came out to explain why the pills now looked different.
Considering the amount of money I spend every month on copays for my “meds,” I was jazzed. I’m the thriftiest person I know, save for my mother, and I buy generic/Costco brand everything. And when I was about 25 and on vacation at Club Med in Mexico, I came back with a carry-on filled with birth control pills.
A few weeks after I started to take the Teva generic Wellbutrin, I started to feel a twinge of sad. I reminded myself, “Emotions are normal.”
A week later, I realized I’d been sad for a while, that low-grade sadness, the physical ache I knew too well. It sits in an indefinable place inside me, a fresh rug burn in a place so deep in my solar plexus I can only reach it when I’m at yoga doing cat/cows. As the commercial for a particular SSRI says, depression “hurts.”
I went back in my head to see if anything had happened in those few weeks, and the only thing I came up with was the switch to the generic. I called my doctor, who told me that the FDA does allow for some differences between brand-name drugs and their generic equivalents, and that there can be as much as a 3.5 percent different in the rate of absorption.
Armed with this disturbing fact, we agreed I’d switch back to the brand name, and within a week or so I was feeling nearly better. I called my insurance company’s customer service department and told them the problem. They insisted on routing my call to the pharmacist, who assured me that the 3.5% difference was teeny weenie, negligible, and that there’s no possible way that the switch had caused a return of my depression.
I tried to have a conversation with him about the fact that generics sometimes do not work, and I was treated like an unhinged conspiracy theorist.
The reason I knew about generic medication, and about a whole lot of things about other medications and healthcare in general, is because I was raised by a physician and grew up with the New England Journal of Medicine on the coffee table. And Vogue. But that’s another story.
The mail-order pharmacist then said that if I really wanted to use the brand name Wellbutrin, I could save some cash by ordering it by mail through the insurance’s pharmacy plan. I would get three months for the cost of two. Jackpot.
I placed my order for the next refill, and accidentally a bottle of the Teva generic Wellbutrin arrived. I called customer service, I was routed to the pharmacy, and the pharmacist told me, again, exasperated, that this wasn’t a possibility.
Now, little riles me more than being told I don’t know what I’m talking about. If someone treats me like a stupid child, I promise you I will use my knowledge to make that person feel so small I could crush him with my foot. But it became quickly obvious that this wasn’t going to happen. I was transferred back to customer service and was told I could not get a refund.
I called my doctor, we decided to try it one more time, and one more time the Teva generic Wellbutrin spiraled me toward a depressive episode. Since I’d now paid for the generic and used up all my “refills” for the next several months, the office manager at my psychopharm’s office rounded up enough brand name samples to get me through the time until I could get them on my own without paying full price.
In Googling this drug a few years later, I saw that there had been complaints just like mine, with the Teva generic Wellbutrin, and that the FDA had been deluged with them. The company line: We nutty/depressed freaks often have highs and lows, after all. Clearly, we unhinged loonies could not be trusted to tell them when our meds work.
So it took SIX years of complaints for the FDA to do their own testing, and much to their surprise they found the Teva generic Wellbutrin was not, in fact, biologically equivalent to the brand name. The FDA pulled this drug off the market.
I read this in my news feed one morning a few months ago, as I was sitting with my morning coffee. I stared at the screen; hand over my mouth, for a good five minutes. I was right about the drug from the get-go. I wanted to find that smarmy pharmacist and jab a pointy stick into his head.
I sent the hyperlink to the article to my mother. To my best friend, Kate. To another friend who is a medical malpractice attorney (who said I should keep my eyes out for what would most likely become a class action suit from the people forced to take this drug.)
Then I realized that in being forced to pay the co-pays for six years, I’d laid out nearly 3,000 dollars. I wanted it back.
I decided to start by calling the company that handles my RX plan. The customer service woman had no idea what to do with me; I was transferred from manager to manager. Finally, the last manager I spoke with, who had a high-pitched irritating baby voice, said, “If you want a refund, you should call an attorney.”
Fighting words for me, idealist extraordinaire. With that, I Twitter-and-email-bombed the company till someone in the executive Vice President’s office called me. He told me that I’d have to take it up with my health insurer, and then told me that he was sorry. Sorry that the representative I’d spoken to that morning had been unprofessional. Sorry that my dealings with his company, and its pharmacists, had been unpleasant. And sorry that I’d gotten so sick.
That may, if fact, be the only apology I get. I wish it were good enough.
Currently, I have collected all of my Rx bills for this drug for the past six years, and am getting a letter from my psychopharmacologist stating that because he’d watched my perilous decline, and heard the same from other patients, he had encouraged all of us to buy the brand name. That’s where I stand right now, legally.
Mentally, I would like to tell you that once I was back on the brand name Wellbutrin I was fine, but that would be a lie. For whatever reason, this medication incident did something really lousy to the efficacy of my tried-and-true combination. Basically, it took the buzz out of the cocktail.
And it took more than four years of changing things around, mixing it up, trying new things, changing SSRIs three times, and then increasing my dosage of BRAND Wellbutrin to get myself back to where I was beforehand. Why? Nobody knows, not even the psychopharm I pay $275 a half hour.
Was I distraught every day? No. Was I as healthy as I had been before? No.
I'm writing this anonymously because I’m going after my insurance company for the cash I had to dish out in co-pays for name brand Wellbutrin under the guise of “The generic is fine!”
I lost four years of my mental well-being and I’ve only received an apology from the company who gave it to me, yet is not responsible. The good news is that the FDA is starting to get some scrutiny about other generic medications that are neurological in nature. The bad news is that I imagine the wait for my three grand, and that apology, will be a long time coming.