Are Generic Medications as Effective as Brand Names for Bipolar Disorder?

By Julie A. Fast 

Medically Reviewed by Allison Young, MD

Last Updated: 31 Jul 2024

Here’s what you need to know about using generic medications for bipolar disorder, how they compare to brand names, and some useful tips for managing medication changes.

If you or your loved one has been switched to a generic medication for bipolar disorder or are considering making the change yourself, it’s natural to feel unsure. You might wonder whether these more affordable options can truly match the brand names you’ve relied on — especially with all the mixed messages out there. I’ve been through this myself when my pharmacy replaced my Lamictal with generic lamotrigine, and I understand the anxiety and disappointment that can come with such unexpected changes. Let’s dive into the details of brand names and generics.

Unraveling the Generic vs. Brand Mystery

In 2008, I did some heavy research on the topic of brand name versus generic medications when my brand name Lamictal medication was switched to generic lamotrigine. It was very obvious within the first few weeks that the medications were not the same.

I naturally asked my pharmacist and colleagues, “Why does it feel like the generic medication I just tried is not working as well as the brand name medication?” Their responses varied widely, and no one really had a clear answer. I was told, “The pills should be the same.”

As a person who has bipolar disorder and a psychotic disorder, I could physically tell that this newly approved generic (lamotrigine) was not as effective as the brand name I had been on for more than a year. This was in 2008 when GlaxoSmithKline’s Lamictal lost its patent, and the generic drug (lamotrigine) became available.

I knew there was an answer, so I started digging. I had many resources at my fingertips. I was a regular presenter at a well-known pharmacy school and could also talk to my psychopharmacology expert and coauthor, John Preston, PsyD. I even had contact with sales reps for GlaxoSmithKline.

But despite all these resources, I received different answers.

I eventually found an answer that everyone agreed with, and I share it with you now as a change to generic medications affects so many of us who live with or care about someone with a brain illness.

I’ve since tested this information with many of my clients whose loved ones faced a change from a brand name to a generic medication and have found the following to be a safe approach to the topic.

What’s the Main Difference Between Brand Name and Generic Medications?

Here is the short answer: Medications have two components — active ingredients and the vehicle used to get these ingredients into your body. The active ingredients are the original chemical compounds that make the drug effective. The vehicle is added to deliver the active ingredients into your system and can be in the form of a pill, cream, or shot. When you take a brand name medication, both the active ingredient and the vehicle are consistent with each prescription. For generics, the active ingredients must be the same worldwide, but there are no regulations for the vehicle. This is where there can be problems.

The main difference between generic and brand-name medications is how the active ingredients are delivered into the body using a vehicle.

Active Ingredients Are the Same in Brand Name and Generic Drugs

• The term active ingredients refers to the original chemical compounds that make the drug effective.
• According to the U.S. Food and Drug Administration (FDA), the active ingredients in a generic medication must be the same as those in the brand-name equivalent.
• These active ingredients are proprietary in the United States for up to 20 years under a patent.
• When the patent expires, the drug’s active ingredients recipe becomes available for use in generic medications.

The Vehicle Can Differ Widely Between Brand Name and Generic Drugs

• The vehicle delivers the active ingredients into the human body.
• The vehicle includes added ingredients that are combined with the brand name active ingredients to create a usable pill, capsule, shot, cream, or suppository.
• Also known as carrier systems, vehicles play a crucial role but are not regulated as strictly as the active ingredients.
• This difference in regulation can lead to variations in how generic medications perform compared to their brand name counterparts.

Strategies to Manage a Change to Generics

Here are some practical tips to help you or your loved one adjust to a new generic or determine if you need a medication adjustment from your prescriber:

• Chart the reactions to the brand name versus the generic medication. Always carefully chart new medications, especially any change from a brand name to a generic. If you or a loved one isn’t doing well on a generic that is the same dose as the brand name, use the information in this article to get the help you need.
• Give generics time. It may be that the medication needs more time to get into the system.
• Use a different generic manufacturer. The pharmacist can help you find the country of origin and choose a different producer of the same generic.
• Talk with the prescriber. If there is still a consistent problem with the generic, petition the insurance company or disability service and explain the situation in order to return to the brand name or try a different medication. After a year of the generics being on the market, you can try the generics again.

Both of this author’s books, Take Charge of Bipolar Disorder and Loving Someone With Bipolar Disorder, have medication chapters that offer more information on how to create a management plan so that lower doses or even a different medication can be used.

Figuring out bipolar medications takes time and requires a lot of support. Still, ultimately, the goal is to manage as many symptoms as possible using behavior and lifestyle changes so that medications can be taken at lower and more sustainable doses.

For now, start by charting the dosage and source of medication, and if this changes in any way, carefully note any changes in symptoms. It’s much easier for a caregiver to notice changes than the person who is ill, especially if a generic isn’t working, as well as a brand name for mania or psychosis. You can then use your observations to help a loved one get the medication support they need.

Overall, generics are far more economical than brand name medications, and if this means they can offer more access to those who need them, generics are a positive in our bipolar world.

By understanding the full scope of how medications are created and regulated, we empower ourselves to make informed decisions that enhance our health and well-being.

Editorial Sources and Fact-Checking

• Generic Drugs: Questions and Answers. U.S. Food and Drug Administration. March 16, 2021.
• Generic Drugs. U.S. Food and Drug Administration. April 21, 2023.
• Determinants of Market Exclusivity for Prescription Drugs in the United States. The Commonwealth Fund. September 13, 2017.
• Barnes TM et al. Vehicles for Drug Delivery and Cosmetic Moisturizers: Review and Comparison. Pharmaceutics. December 2021.

BRAND NAME MEDICATION, GENERIC MEDICATION, MEDICATION

ABOUT THE AUTHOR

Julie A. Fast

Julie A. Fast is the author of the bestselling mental health books Take Charge of Bipolar Disorder, Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner, Getting It Done When You’re Depressed, OMG, That’s Me! (vol. 2), and The Health Cards Treatment System for Bipolar Disorder. She is a longtime bp Magazine writer and the top blog contributor, with over 5 million blog views. Julie is also a researcher and educator who focuses on bipolar disorder prevention and ways to recognize mood swings from the beginning—before they go too far and take over a person’s life. She works as a parent and partner coach and regularly trains health care professionals, including psychiatric residents, pharmacists, general practitioners, therapists, and social workers, on bipolar disorder and psychotic disorder management. She has a Facebook group for parents, The Stable Table, and for partners, The Stable Bed. Julie is the recipient of the Mental Health America excellence in journalism award and was the original consultant for Claire Danes’s character on the TV show Homeland. Julie had the first bipolar disorder blog and was instrumental in teaching the world about bipolar disorder triggers, the importance of circadian rhythm sleep, and the physical signs of bipolar disorder, such as recognizing mania in the eyes. Julie lives with bipolar disorder, a psychotic disorder, anxiety, and ADD.

It’s so refreshing to hear the affirmation of what I and so many others go through. I had an issue in the 90’s with Wellbutrin 300. The main manufacturer of the generic version did not complete the studies correctly. They also made a 150mg tablet and when it came to testing the 300mg they only double the 150mg study and did not actually study it. The calculation was wrong and those who took the medication suffered for years before they admitted what they did. The manufacturer and the FDA failed because the FDA is required to study the results of all tests to make sure the higher doses are as effective as they say they are. The manufacturer was no longer able to sell their drugs in The United States and banned from future sales. The situation is different and only applied to one manufacturer but it’s still important for everyone who takes generics to understand how they work differently, make informed decisions, and log how the medication is working or not when you start a new generic after taking the brand name.

Melinda