Effexor XR, a popular antidepressant, is probably no more affective than other such medications, and unlike other antidepressants, Effexor is associated with hypertension and serious withdrawal symptoms. But doctors who got information from physician -lecturers paid by Wyeth Pharmaceuticals to promote Effexor XR might not know that. According to a former Effexor XR physician-lecturer who recently came forward to describe his experience in this role, the Effexor information provided during such talks was often incomplete, downplayed risks, and was skewered to favor Effexor over other drugs. Dr. Daniel Carlat recently recounted a story in the New York Times that raises serious questions about the ways pharmaceutical companies often market their drugs.
According to Dr. Carlat, a psychiatrist with a specialty in psychopharmacology, Wyeth first approached him in 2001, asking if he would be willing to give talks to primary care physicians about Effexor XR, a drug used in treating depression. Effexor XR was being marketed by Wyeth as a better alternative to antidepressants like Paxil, Prozac and Zoloft. Effexor XR works by increasing the brain’s uptake of the neurotransmitters serotonin and norepinephrine, both of which effect mood. Traditional antidepressants like Paxil only increase serotonin uptake. Dr. Carlat was familiar with some positive studies involving Effexor XR, and had prescribed it to his patients. Wyeth’s offer of a $500-$750 stipend for each Effexor XR talk he gave helped convince Dr. Carlat to take the company up on its offer.
Dr. Carlat and was first sent by Wyeth to a conference in New York City, where the doctor would receive “education” on Effexor XR. The drug company put Dr. Carlat and his wife up in a posh Manhattan hotel, provided the couple with tickets to a Broadway Show, and paid him $750 just for attending the conference. At the Effexor XR “education classes”, prominent scientists – all paid by Wyeth –touted the drug as a big improvement over other medications. One researcher emphasized Effexor XR’s remission rate – complete cure -which the company said was 10% better than other antidepressants. This bothered Dr. Carlat somewhat, as antidepressant effectiveness is usually measured by response rate, which is defined as a 50% improvement in symptoms. In his New York Times piece, Dr. Carlat admits that he wondered if Wyeth had chosen to emphasize remission in order to make Effexor XR look better than it truly was.
Another researcher spent much of his lecture downplaying Effexor XR’s association with high blood pressure – a side effect not shared by other antidepressants. According to the speaker, Effexor XR only had a slight chance of elevating blood pressure. The conference also downplayed problems experienced by people who stopped taking the drug – including dizziness, mood changes, and even nervous breakdowns – that where more serious than those associated with other antidepressants.
At the end of the conference Dr. Carlat went home to begin with his new role as “Dr. Drug Rep.” But as month’s passed, he became increasing uneasy serving as an Effexor XR cheerleader. For one thing, Dr. Carlat kept up with Effexor XR developments, and as more research became available, it was clear that Effexor was not significantly better than other antidepressants. He also learned that some of the Wyeth studies cited at the Effexor XR conference had been conducted in a way that was beneficial to Effexor. Dr. Carlat also became aware of studies that showed Effexor XR’s risk of hypertension was greater than previously thought.
Still, Dr. Carlat continued giving Effexor talks, downplaying risks and highlighting benefits. Finally, during one of his Effexor lectures, Dr. Carlat was challenged by a doctor over Wyeth’s hypertension data. This bothered him enough that he altered his lectures from the approved Wyeth format, and decided to begin ending his Effexor talks with the caveat that the Effexor studies he cited were mainly short-term, and that there was a possibility that other antidepressants were just as effective as Effexor. The first lecture he gave with this warning resulted in Dr. Carlat receiving a visit from a Wyeth district manager, concerned that the doctor was not exhibiting enough “enthusiasm” in his talks. According to Dr. Carlat, he decided then and there to end his association with Wyeth.
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