Pressures to contain pharmaceutical expenditure have led to increased prescribing and dispensing of generic drugs in addition to low prices for generics. Atypical antipsychotics are prescribed for schizophrenia leading to resource pressures with their higher acquisition costs than typical antipsychotics. Drug costs can be reduced once multiple sources are available. However, this must be balanced against possible efficacy, safety and compliance concerns given the high cost of relapses for patients with schizophrenia. Generic clozapine has been launched. There was an increase in relapse rates with early formulations in the USA. However, this has not been the case with more recent formulations. Despite this, there could be patient and physician concerns when additional generic atypicals, such as olanzapine are available, reducing potential savings. A retrospective survey of patients prescribed Zyprexa((R)), generic olanzapine or both, over an extensive period was undertaken in Poland to help address these concerns given the difficulties with conducting randomized clinical trials with generics in complex situations. The survey showed similar effective doses of olanzapine in all groups. Relapse rates were similar in patients before and after switching to generic olanzapine, and no untoward side effects were seen in any patient prescribed generic olanzapine. Consequently, generic olanzapine should be welcomed with savings redirected to improving compliance or funding new premium priced drugs that can reduce relapses in refractory patients. This should give reassurance to health authorities to continue their reforms where pertinent to optimize resources by increasing availability of generics.

Market forces appear to drive down the prices of generics and originators as more atypical formulations are launched. However, alternative approaches may be needed if significant co-payment differences compromise individualized care.

Depressive disorders are the fourth most common disease causing the patients' disability worldwide. They are associated with increased morbidity and mortality, not only because of the increased risk of suicide but also because of cardiac complications and stroke. Depression also results in negative economic impacts due to exclusion of treated patients from their daily activities. There is an increased frequency of consultations and hospitalizations in patients with depression. On average, over one third of patients do not respond or poorly respond to conservative treatment. Vagus nerve stimulation (VNS) may be effective in these patients. In March 2001, VNS was recognized in Europe as a treatment for depression in patients who are refractory or intolerant to conservative treatment, both in cases of major depressive episodes and in bipolar disease. In the United States, the method was recognized by the FDA in July 2005 as an adjunct treatment for long-term chronic refractory depression or for recurrent major depressive episodes refractory to conservative treatment in patients over 18 years of age who did not improve after four or more schemes of antidepressant therapy. The following is a report of two cases of patients with depression treated by left VNS.