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People’s Pharmacy: Generic antidepressant laxity

Q: I wrote to the Food and Drug Administration about the side effects of generic Prozac (fluoxetine). When I take this generic antidepressant, I think about suicide a lot.

I never heard back from the FDA. Apparently, it couldn’t care less.

As a result, I have to pay $1,400 every three months for a Prozac prescription. Generic fluoxetine is about $4, but it’s not even worth that much.

A: You are not the first person to complain about problems with generic antidepressants. Another reader wrote, “Two weeks ago, my pharmacy switched me to a new generic fluoxetine, and it’s like taking a sugar pill. All of my symptoms are back. I couldn’t even make it to work today.”

The FDA doesn’t respond to such messages. It is important to report problems, however, because the agency may investigate, especially if the manufacturer is named. The best way is online at FDA.gov/safety/medwatch/ or by calling 888-463-6332.

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Q: I enjoyed your article about ticks, but you left out an important strategy my family uses: permethrin-treated clothing. In tick season, we spray our shoes with permethrin every month and have a couple of treated outfits we wear when we are walking the dog in the woods.

Forest Service staff use clothing that has been pretreated, but we spray ours. I like that better than coating ourselves and our children in DEET before they go out to play.

A: Keeping ticks off is the best tactic in preventing tickborne diseases such as Lyme. That is why we suggested tucking pants legs into socks and treating them and shoes with repellent. A comparative study found that BioUD was more effective than permethrin and just as effective as DEET against lone star ticks (Medical and Veterinary Entomology, June 2011).

Another old-fashioned tactic is to dust socks and shoes with powdered sulfur. Take care not to inhale it, as it can be irritating to the lungs.

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Q: I am having a lot of trouble sleeping. Since my husband died, I’ve needed something to help me sleep.

For years, I’ve taken Tylenol or Advil PM along with alprazolam. I’ve read that alprazolam can contribute to dementia and would like to get off it. Do the “PM” pills also contribute to dementia?

I usually can get to sleep, but without medication I wake up soon afterward and toss and turn for hours. I know I should drink relaxing tea, not use the computer at nights and so on, but none of this helps me stay asleep.

Are my sleeping pills harmful? If so, what else can I do to get some sleep?

A: Your sleep aids could cause problems. Diphenhydramine, the sedating compound in “PM” pills, is an antihistamine with adverse effects on memory and cognition, especially for older people (Sleep, July 2006). We also worry about alprazolam. In a recent review, researchers documented an increased risk of dementia for people taking drugs in this class (Expert Opinion on Drug Safety, May).

Other approaches, including herbs that may help, are discussed in our “Guide to Getting a Good Night’s Sleep.” Anyone who would like a copy, please send $3 in check or money order with a long (No. 10), stamped (70 cents), self-addressed envelope to: Graedons’ People’s Pharmacy, No. I-70, P.O. Box 52027, Durham, NC 27717-2027. It also can be downloaded for $2 from our website: PeoplesPharmacy.com.

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Q: I use dandruff shampoo every other day but get no relief. I am a 57-year-old woman.

A. If you have been using the same dandruff shampoo for weeks on end, that may be contributing to the problem. Dermatologists suggest that it is best to alternate different anti-dandruff ingredients.

In practical terms, that means using a product with selenium sulfide (Selsun Blue, Head & Shoulders Clinical Strength, Exsel) for a week or two and then switching to a tar-based product such as Neutrogena T/Gel, Denorex or Biotene H-24. After a few weeks, switch again to a zinc-pyrithione-based product such as Denorex Everyday or Head & Shoulders.

An antifungal shampoo such as Nizoral with ketoconazole also could be thrown into the mix. Changing the product you use can keep the Malassezia yeast responsible for those itchy flakes from developing resistance to one chemical.

Pretreating your scalp before shampooing with a home remedy such as apple cider vinegar, original amber Listerine or milk of magnesia also may contribute to success.