I danced around the truth to make the drug reps happy: Effexor and its side effects

The Story of "Dr. Drug Rep:"

On a blustery fall New England day in 2001, a representative from Wyatt Pharmaceuticals came into my office and made me an offer I found hard to refuse. He asked me if I'd like to give talks to other doctors about using Effexor XR for treating depression. I'd get $500 for one-hour "Lunch and Learn" talks at local doctors' offices, or $750 if I had to drive an hour.

I had a busy private practice in psychiatry, specializing in psychopharmacology. I was quite familiar with Effexor, since I had read recent stories showing it might be slightly more effective than Prozac, Paxil, Zoloft, and other selective serotonin reuptake inhibitor (SSRI) anti-depressants.

I [agreed and that year I] made about $30,000 in supplemental income from these talks.

[A question from the audience of one of the talks I gave made me realize that] I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.

I had not lied – I reported the data exactly as they had been published. But still, I had spun the results of the study in the most positive way possible. I realized that in my canned talks, I was blithely minimizing the hypertension risks of Effexor. There was another problem: one of Effexor's side effects. Gradually it became clear that there were "withdrawal" symptoms.

A recent study found that one-fourth of U.S. doctors receive drug money for lecturing to physicians or helping market drugs in other ways.


To his credit, Dr. Carlat now publishes a medical education newsletter for psychiatrists that critically assesses drug research and marketing claims. The newsletter is not funded by the drug industry.

Doctors want to learn about the most recent drugs so they can help patients, and they more readily believe other doctors than laymen drug reps. Doctor may know best, but money talks.

Advice: Ask your doctor's office manager if the doctor gets money from a drug company.

Browse for related stories in the index at the very bottom of this page, or read an Effexor misuse story.

Thanks to Dr. Daniel Carlat for the source article in today's New York Times Magazine.

Warning on antidepressant and antipsychotic drugs: Drug-drug interaction

A 45-year old man from Boston had been taking four drugs for depression when he had ankle surgery in December. When the anesthetic wore off, he was given Fentanyl in the recovery room. He suddenly developed tremors and violent shaking, and started cracking his teeth, according to his wife. Moved to the Intensive Care Unit, he thrashed and flailed, oblivious to those around him, and had to be restrained physically. Two weeks later, he was still in intensive care, very confused, well after his drugs had been discontinued. The same “serotonin syndrome” had caused the death of Libby Zion in 1984.

At especially high risk of such serotonin poisoning are patients on combinations of antidepressant drugs and antipsychotic drugs that are sometimes prescribed to treat resistant depression. It can result from a combination of an SSRI (Selective Serotonin Reuptake Inhibitor, like Zoloft, Prozac, or Paxil) or an MAOI (Monoamine Oxidase Inhibitor, like Marplan, Nardil, and Eldepryl, and another serotonin-raising substance.

Advice to patients taking these drugs: Ask your pharmacist and doctor about possible drug-drug interactions.

Read another of
our stories of a drug-drug interaction, or the blog post of Dr. R. W. Donnell, Jane Brody’s story in today’s NY Times, “A Mix of Medicines that can be Lethal,” and the review article in the New England Journal of Medicine.