Honey's supportive doctor

I talked with Honey's PCP a while ago on the phone.
I am always impressed with the time she gives Honey and I both on the phone and in the office. I never feel like I am wasting her time nor do I feel like she is thinking that I need to stop telling her (PCP) what I need.
I had a couple goals concerning our conversation.

First, I wanted to update her as to what is going on (that we had not started reducing, that Honey was still trying to transition from tablets to liquid (while maintaining "stability"), and wanted her to know that Honey is just now feeling completely "normal" since the TEVA form of sertraline experience. I told her that I thought "Honey must be pretty sensitive to this medication". I feel if I say this (instead of saying the drug/poison "sucks" and is killing people) that I will not put her on the defensive and still have her seeing that my ideas about tapering really slow and cautiously is best for "Honey".
That goal met.

Second goal was to express my concern over transitioning to the liquid and shared with her my "information" regarding the possibility that the liquid might also trigger withdrawal symptoms (like the TEVA did for Honey) and that I wanted to transition slowly (from tablet to liquid) as well as keep her on at least 12.5mg of the tablet while decreasing the liquid.
Goal met-- she probably thinks I am nuts, but she said she definitely was okay with that and would continue to write refills for both the liquid and tablets as long as needed- would I just keep her updated- I almost thought it sounded like she meant "Keep educating her on this process".

Third goal: Ask PCP if she would write a note for school to inform school of Honey's diagnosis and let them know that she was having medications adjusted and the adjustments might cause physical and psychological symptoms. This is what I asked her to write (or something along those lines)-- we will see what we get. I also asked if she would be willing to help out as needed as far as school goes and she said "Certainly".
third goal met (haven't seen the note yet, but anything at this point from her that informs school of her diagnosis and med changes and knowing that PCP will back us as needed is all I need to get things started with school.
I feel like I accomplished something.

Honey continues to do well. We have started daily documentation as far as dosage, Honey's moods and any physical symptoms- so we will have a good baseline to go by when we start reducing and making poison (med) changes as far as form (tablet to liquid). This is our plan for now:

Currently (for the past 10 days 3/10- 3/19) she is taking 37.5mg Zoloft - 12mg liquid (.6ml) and 25mg tablet.
Starting tomorrow 3/20 she will take ¾ of a 25mg tablet (18.75mg) and 19mg liquid (.95ml) She will continue this for 10 days (until 3/29) as long as there are no withdrawal symptoms.
At that point (on 3/30- Thursday) we will try ½ tablet (12.5mg) and 25mg liquid (1.25ml). After 10 days (starting 4/9) on this ratio of tablet to liquid, I would like to start reducing the liquid (as long as she is baseline). We will reduce at 5% (actually just a bit more) of the total dose of 37.5 (actually reducing 2mg/.1ml). We plan to have her stay at this dose until she feels baseline or better. (at least 2 weeks on this dosage) and will reduce from there as tolerated.
I plan to keep her on 12.5mg of the tablet (½ tablet) as she reduces the liquid. I will have to worry about making a transition with the remainder of the tablet later. (Once she has reduced a good deal of the liquid)

I have never felt this way before... like a pioneer? I feel like Honey and I are creating a map. We can talk to other pioneers, who have been this way before, but their map might be different or maybe they have not been "here" before. Weird. I dont like being here and I dont like being here without a proven map. Honey hates it. But in a way (?) it is actually empowering (?) (I am sure I will take this "empowering" thing back)
It is also weird trusting my gut to this degree. Trusting it over science and mainstream practice. I am proud of my intuition/gut and proud that I listened, as it knew to go slow with the liquid, even before I understood that there might actually be theory behind it (might bring about withdrawal symptoms??- theory/thought)

Uchenna Agu (as in Uchenna and Joyce from Amazing Race All-Stars (yes, I watch)) said something on last night's episode that I loved. I dont have his exact words but it went something like this: By not trusting your instinct/gut/intuition, you are basically telling God or the Universe that He (God) is wrong. Like I said, I got his exact words wrong, but I think I got the gist of it correct. I am going to look for his exact words, because they were great.

More on the generic form of sertraline

Well, I cant just let this go-- let it be a lesson learned and move on.
I cant because I am sure it will be weeks before Honey is back to "Honey normal" again after this lesson, and it is really making me mad.

Found this interesting bit on Zoloft and the generic form written by Michael Craig Miller, M.D. Editor in Chief, Harvard Mental Health Letter

"The FDA requires that a generic drug be essentially similar to the brand-name version. It should contain the same amount of active drug. It must be taken by the same route (for example, by mouth). And at a given dose, it should deliver about the same amount of active ingredient into the bloodstream — anywhere from 20% less to 25% more than the brand-name drug.
It doesn't always deliver exactly the same amount because generic pills contain inactive substances that distinguish them from the original. In fact, the U.S. government actually requires this, to prevent fraudulent marketing. The otherwise inactive substances in a pill can affect how the active chemical is absorbed by the bloodstream, delivered to its target, and eliminated; for example, it may break up faster or more slowly in the gastrointestinal tract."

Should deliver "about the same"????
20% less to 25% more is about the same???

For the life of me, I can not understand why this is acceptable. With ANY drug, but specifically an SSRI.

Because, with an SSRI, it seems that the risk of suicide increases when the dosage of the SSRI is CHANGED (starting/stopping/dosage changes)

On the medication guide (that I just received for the FIRST TIME with Honey's script for Zoloft oral concentrate two days ago) tells me that I should be particularly watchful of Honey whenever an antidepressant is started or its dosage changed.

How could I know that her dosage was being changed, when it was changed without my knowledge or consent... all at the approval of the FDA?

Not like I needed another reason to distrust the FDA.

Teva Announces Launch of Generic Zoloft

Is Teva sertraline/generic sertraline equivelant to Pfizer Zoloft?

Well, this makes all the sense in the world (if it is true?- wonder how I find out?)
Honey has been on this Teva form of sertraline and I think she is having withdrawal symptoms... well, it is not our imagination and I am not going to blame my poor pill cutting skills anymore. The above link is to a message board - a conversation others are having on the difference between Teva sertraline, Greenstone sertraline (greenstone being a Pfizer subsidiary) and Pfizer Zoloft. There are 379 comments concerning this issue. Most of them in agreement that something is wrong with the generic form- that they are having symptoms of withdrawal (though many of them dont know what is happening to them)

I also found some interesting thoughts here
and here at crazymeds.org on generic vs. brand.

Well, I think I have resolved one issue- Honey is in withdrawal and it is because of the freaking drug (teva form of sertraline)
So now, wonder what I do?
Do I continue with 37.5mg doses?
I have no idea what she has been getting. But yes, she needs to get stable again.
This is my plan (if we get what we need from the doctor today):
(But wondering now if doctor can give me a mix of these two forms of zoloft?)

oral concentrate form of zoloft
I also plan to ask for a script for 25mg Zoloft tablets – hoping for a couple weeks worth. Honey would take 1.5 of these tablets. I know it is going to be a short wait for the liquid (if she gets it) since it is not stocked where I plan to go for her rx. (It wasn’t stocked regularly anywhere around here). I am done with Teva. So she will need tablets until the liquid is available for us. I thought about this-
Tablets until liquid is ready then:
1 tablet and 12.5mg of the liquid (.62ml- haven’t quite figured it out yet) for a couple days, then ½ tablet and 25mg of the liquid until I am out of tablets. I just feel like it should be a gradual shift from tablet to liquid.
But, what do I know… well, I guess I know I need to trust my gut.