The Carlat Psychiatry Blog: Wyeth Reps Trash Pristiq

Monday, April 7, 2008

Wyeth Reps Trash Pristiq

Read this message board over at Cafe Pharma for an interesting though rather alarming thread about Wyeth's newly approved antidepressant, Pristiq. Cafe Pharma is a site frequented by drug reps, although because postings are anonymous, one never knows whether a given comment is actually from a rep or from an outsider with an agenda. Nonetheless, this particular thread sounds real, because it involves Wyeth reps grousing about upcoming layoffs (layoffs which the company has, in fact, announced) and about the new Pristiq sales force tag line: "People, Passion, Performance...Pristiq!"

Here is one rep's snide take on his company's upcoming campaign:

"PEOPLE - 1/2 of you will be gone in less than 27 days

PASSION - There is no passion now, but for those that remain with Wyeth, we will bribe the passion out of you by taking you to Vegas for 4 days.

PERFORMANCE - You thought it was hard to reach your performance incentive before? Wait until 2nd quarter

PRISTIQ - Good luck selling both Effexor XR and Pristiq at the same time. So Dr., would you like to hear about my antidepressant that has been around for 12 years, with proven efficacy with the ability to titrate the dose as need to better care for each patient's needs that will have generic competition in 4 months, or would you like to hear about my brand new antidepressant with one dose, less indications and less evidence of efficacy? You want me to choose, let me check with my bonus plan to see which one pays more."

If this is the typical attitude within the Pristiq sales force, Wyeth may end up a little shy of the blockbuster they were hoping for!

10 comments:

Anonymous said...: Something of interest to any who practices psychiatry:
In the state I work, Medicaid does not pay for Lexapro now, as they are wise to the fact that Celexa is a $4 RX, while lexapro is what, $100 or more?
So, with this situation, you would think Wyeth would use a little common sense and realize either price this copy equal or less to Effexor to get onto insurer formularies, or just give it away for the first year or so.
Oh, I forgot. It's a patent extender. This is one doc who will not be writing for this drug, as my patients can't afford it or I would be spending my days faxing authorizations.
Maybe it should be called Mystique.
As in, what are these companies thinking with these me too drugs?
Me too dum to figgur it out!!?

live well, love much, laugh often.; April 7, 2008 at 10:13 PM
Supremacy Claus said...: Dan: From the site to which you linked. Requires no comment from me, "They are letting half of us go and the first word that they choose is "people"? Now that's not right....."

I do not appreciate your leaving that out.; April 9, 2008 at 2:11 PM
soulful sepulcher said...: like Invega? the dollar store wonder drug, flat as a can of sprite left in the reps car all day.; April 9, 2008 at 11:58 PM
Supremacy Claus said...: Steph: How do you know anything about Invega?; April 10, 2008 at 12:16 AM
Supremacy Claus said...: I enjoy the hypocrisy of the left. My loving, well thought out analysis posts get deleted. Japanese porn involving plastic wrap, and something called Tin Tin Puremium. Not a problem.; April 11, 2008 at 10:49 PM
Anonymous said...: Doctors need to use their brain and not prescribe des-venlafaxine as it is no better than venlafaxine. Pharma companies need to be rewarded for good new drugs not these lame patent extenders. No enantiomers are better than their ratio mixtures. Certainly not enough to justify their cost.; May 1, 2008 at 7:10 PM
Anonymous said...: Current Depression Medications: Do The Benefits Outweigh the Harm?

Presently, for the treatment of depression and other what some claim are mental disorders, some of which are questionable, selective serotonin reuptake inhibitors are the drugs of choice by most prescribers. Such meds, meds that affect the mind, are called psychotropic medications. SSRIs also include a few meds in this class with the addition of a norepinephrine uptake inhibitor added to the SSRI, and these are referred to SNRI medications. Examples of SNRIs are Cymbalta and Effexor

Some Definitions:

Serotonin is a neurotransmitter thought to be associated with mood. The hypothesis was first suggested in the mid 1960s that this neurotransmitter may play a role in moods and emotions in humans. Yet to this day, the serotonin correlation with such behavioral and mental conditions is only theoretical. In fact, the psychiatrist’s bible, which is the DSM, states that the definite etiology of depression remains a mystery and is unknown. So a chemical imbalance in the brain is not proven to be the cause of mood disorders, it is only suspected with limited scientific evidence.

Norepinephrine is a stress hormone, which many believe help those who have such mood disorders as depression.

And depression is only one of those mood disorders, yet possibly the most devastating one. An accurate diagnosis of these mood conditions lack complete accuracy as they can only be defined conceptually, so the diagnosis is dependent on subjective criteria, such as questionnaires. There is no objective diagnostic testing for depression. Yet the diagnosis of depression in patients has increased quite a bit over the decades.

Several decades ago, less than 1 percent of the U.S. population were thought to have depression. Today, it is believed that about 15 percent of the population have depression at some time in their lives. Why this great increase in the growth of this condition remains unknown and is subject to speculation. What is known is that the psychiatry specialty is the one specialty most paid to by certain pharmaceutical companies for support of their psychotropic meds, as this industry clearly desires market growth of these products, as this objective is part of their nature. Regardless, SSRIs and SRNIs are the preferred treatment methods if depression or other mood disorders that may be suspected by a doctor.

Over 30 million scripts of these types of meds are written annually, and the franchise is around 20 billion dollars a year, with some of the meds costing over 3 dollars per tablet. There are about ten different SSRI/SRNI meds available, many of which are now generic, yet essentially, they appear to be similar in regards to their efficacy and adverse events. The newest one, a SNRI called Pristiq, was approved in 2008, and is being promoted for treatment for menopause. The first one of these SSRI meds was Prozac, which was available in 1988, and the drug was greatly praised for its ability to transform the lives of those who consumed this medication in the years that followed. Some termed Prozac, ‘the happy pill’. In addition, as the years went by and more drugs in this class became available, Prozac was the one of preference for many doctors for children.

Furthermore, these meds have received additional indications besides depression for some really questionable conditions, such as social phobia and premenstrual syndrome. With the latter, I find it hard to believe that a natural female experience can be considered a treatable disease. Social phobia is a personality trait, in my opinion, which has been called shyness, which probably should not be labeled a treatable disease as well. There are other indications for certain behavioral manifestations as well with the different SSRIs or SRNIs. So the market continues to grow with these meds. Yet, it is believed that these meds are effective in only about half of those who take them. The makers of such meds create such conditions besides depression for additional utilization of these types of medications, and are active and have been active in forming symbiotic relationships with related groups, such as providing financial support for screenings for the indicated conditions of their meds- screening of children and adolescents in particular, I understand.

More concerning, however, is the adverse effects associated with these types of meds, which include suicidal thoughts and actions, violence, including acts of homicide, and aggression, among others. While most are approved for use in adults only, prescribing these meds to children and adolescents has drawn the most attention. The reasons for this attention are the off-label use of these meds in this population, yet what may be most shocking is the fact that some of the makers of these meds did not release clinical study information about the risks of suicide as well as the other adverse events related to such populations, including the decreased efficacy of SSRIs in general, which is believed to be less than 10 percent more effective than a placebo. Paxil caught the attention of the government regarding this issue some time ago for hiding such important information, for example, some time ago.
And there are very serious questions about the use of SSRIs in children and adolescents regarding the effects of these meds on them. For example, do the SSRIs correct or create brain states considered not within normal limits? Are adolescents depressed, or just experiencing what was once considered normal teenage angst? Do SSRIs have an effect on the brain development and their identity? Do adolescents in particular become dangerous or bizarre due to SSRIs interfering with the myelination occurring in their still developing brains? No one seems to know the correct answer to such questions, yet the danger associated with the use of SSRIs does in fact exist. It is observed in some who take such meds, but not all who take these meds.

Finally, if SSRIs are discontinued, withdrawals are brutal, and may be a catalyst for suicide in itself, as not only are these meds habit forming, but discontinuing these meds leaves the brain in a state of neurochemical instability, as the neurons are recalibrating upon discontinuation of the SSRI. This occurs to some degree with any psychotropic med, yet the withdrawals can reach a state of danger for the victim in some classes of meds such as SSRIs.
SSRIs and SRNIs have been claimed by doctors and patients to be extremely beneficial for the patient’s well -being regarding the patient’s mental issues where these types of meds are used, yet the risk factors associated with this class of medications may outweigh any perceived benefit for the patient taking such a drug. Considering the lack of efficacy that has been demonstrated objectively, along with the deadly adverse events with these meds only recently brought to the attention of others, other treatment options should probably be considered, but that is up to the discretion of the prescriber.

“I use to care, but now I take a pill for that.” --- Author unknown

Dan Abshear; May 14, 2008 at 1:13 PM
Anonymous said...: I just started taking pristiq while going off nefazodone.after one week of 50mg of pristiq and 15mg remeron i am feeling well.the combination of these 2 drugs go very well. I highly reccomend them together.as far as pristiq, side effects compared to effexor side effects, pristiq has much less side effects!; June 25, 2008 at 10:32 PM
Anonymous said...: I am not paying any attention to any negative feedback about Pristiq,it
is the only medication that I have
taken w/out any side effects AT ALL!
believe me, I have tried them all.
I am taking Pristiq and am no longer
depressed,that is all that matters
to me.; June 24, 2009 at 8:53 AM
Anonymous said...: Last time I studied chemistry I seem to recall that a very small change in a molecule could make a monumental difference in what it did and what it was. I'm glad that some drug reps and Dr.s believe that they know with such certainty what change is significant and what isn't. And what hypocrisy to bring cost into the discussion. Like the price everyone pays for medication makes any sense? Give me a break
Here's what I know .. I've suffered with depression ..deep dark depression .. for a long time. I've tried Celexa (useless to me), Effexor (very helpful but loaded with weird little side effects), Cymbalta (not that great but OK), and now I'm on Pristiq. It works as well as Effexor did for me but without the weird side effects. I feel significantly better. Since none of the medical and drug manufacturing minds have yet figured out what exactly is going on in the brain of a depressed person I guess we're left to that very "unscientific" matter of whether or not a patient feels better after taking a medication... or not. Imagine that .. what a revolutionary way to evaluate something - by asking patients if it relieves their symptoms.; February 16, 2011 at 10:38 PM