…”Mulling over these questions, I wandered into the Wyeth Ayerst product display area for the drug Effexor, named “Wellness Park” on an enormous banner.  I struck up a conversation with a sales representative from Florida, who had taken some anthropology courses in college.  We chatted about the displays, many of which showed the same smiling woman in three photographs, the first faded out, the second normally exposed, and the third vividly coloured.

“We are trying to achieve a higher standard in care for depression,” she offered, to explain the vivid colouring in the third photograph.  Effexor will help patients be better than they were even when they were not depressed. Doctors need to have higher expectations for their patients and this is what the three photos of the three photos of the smiling women show, that none of them is depressed anymore, but there are higher degrees of life satisfaction, performance, and functioning.  She then referred me “upstairs” to a pharmacist who could answer more questions and give me technical literature.  I found a spiral staircase, which wound about a life-sized artificial tree trunk along the way.  The many, luxuriantly leaved boughs of this tree shaded the whole display area and gave concrete meaning to the “Wellness Park” theme.  There was a heart carved into the bark of the tree enclosing chemical symbols for serotonin and for another neurotransmitter, norepinephrine, which represent the two pathways Effexor works on in the brain.

Upstairs in the tree house, I was offered a seat on the other side of a desk from a pharmacist.  In response to my question about the significance of the three photographs, he said,

“The FDA grants efficacy for depression when studies find people are 50% less depressed on the HAMD scale (a standard scale for measurement of depression) than before treatment.  This is defined as a “response”.  But Effexor gives even more response than that, and have termed this “remission”.  Remission means return to a virtually asymptomatic state.”

He showed me a brochure in which Effexor is said to lead to “more complete and sustained improvement” and then a reprint from the Journal of Clinical Psychology called, “Why Settle for Silver When You Can Go for Gold?”  The reprint stated that remission, not “response only” will yield “energy, zest, and social drive.”  In the pharmacist’s words:

The science of depression is to reach a higher standard.  The higher standard can be attained by Effexor because it has a dual mechanism, like the old antidepressants, the trycyclics, which had both a serotonin reuptake inhibitor and a norepinephrine reuptake inhibitor.  Those drugs worked very, very well, except for their sever side effects.  With the dual mechanism and without the side effects, Effexor works better than other antidepresants which are only SSRIs.

This has implication for the patient – can s/he go back to work?  And it has an economic impact – will people be more productive?” – Emily Martin, Bipolar Expeditions.

The implications of many of these statements are immense.  So Tricyclics were similar to Effexor, they were also SSRIs!…but had too many side-effects…

Remission, a term usually reserved for cancer patients, but now used to describe a state of permanent dependence on Effexor (as I take this drug, this is the only way I can interpret the statement).  Cancer patients in remission aren’t dependent on chemotherapy – chemical therapy – just like what Effexor performs, but on the brain…

I would like to create a “park-like” exhibit that depicts the reality of Effexor.  Lightning bolts would suddenly go off and visitors would have devices strapped to their wrists that caused them to experience brain-zaps.  The grassy floor would be very uneven, so one may trip more easily than usual.  There could also be an Effexor withdrawal room that would enforce how important it is to stay on the drug, as one would enter a room filled with fog, 0% visibility.

Any other ideas?