There’s nothing like a ringing endorsement for your latest drug or, in the case of Wyeth’s Pristiq, your latest FDA approval. Pristiq, after all, isn’t a new drug - it’s a version of Effexor, the big-selling antidepressant that faces patent expirations. And that’s why Wyeth was so tickled last week to finally win FDA approval after repeated delays.

But that doesn’t necessarily mean every psychiatrist or doctor will take a shine to Pristiq. As Michael Liebowitz, the Columbia University psychiatrist who led the major Pristiq trials, tells The Carlat Psychiatry Blog, the pill is no big deal.

To wit: Pristiq, he says, “is another SNRI - it is not a revolutionary drug.” It may be more tolerable at the starting 50 mg dose, Liebowitz tells Carlat, but only time will tell if it truly is clinically useful. “If it is useful, then it will make money for the company, and if it is not, it won’t.” You can bet Wyeth won’t be featuring Leibowitz in its promotional campaign anytime soon.

Please continue for an UPDATE…

On March 11, Carlat posted a letter from Liebowitz, seeking to clarify his remarks. In fairness, we are also running his comment, which also appeared on Carlat’s blog…

“Your blog posting suggesting I was unenthusiastic about Pristiq mischaracterized my views. It is very useful for clinicians to have another serotonin-norepinephrine reuptake inhibitor (SNRI) available to treat depression. This class of antidepressants is very useful for treating an often disabling and sometimes life threatening condition, and the more tools we as clinicians have available, the better we can serve our patients. In addition, Pristiq’s very tolerable starting dose of 50 mg per day may also turn out to be its usual therapeutic dose, avoiding the need for dose escalation. If so, this would differentiate it from Effexor XR and Cymbalta, the two previously marketed SNRI’s.

“With regard to my remark that if Pristiq was useful, it would make money for Wyeth, this was in response to your question about whether the company was marketing it for altruistic or commercial reasons. The intent of my comment was twofold. First, I believe that it was not an either-or proposition. Rather, if the drug turned out to be highly useful, it would also be highly profitable, so a company can be motivated both by wanting to advance science and health care and make a profit. Secondly, how widely a given drug will be used is not always something one can usually predict until a drug is marketed and clinicians have a chance to test it out in daily clinical situations. For example, who would have predicted that Celexa or Lexapro, marketed for depression after numerous other SSRI’s, would turn out to be very useful, popular and widely used drugs.”