This article originally appeared in the November 6, 1992 issue of the Boston Phoenix.
Ever had a panic attack? If not, you will soon. The Upjohn Company is busy educating the public about panic disorder, and though the diagnosis is legitimate, Upjohn’s interest is proprietary: it manufactures Xanax, the only drug approved for the treatment of panic.
Symptoms of a panic attack include rapid heartbeat, chest pain, and dizziness. The typical patient is a woman who, after several attacks in a shopping mall or in traffic, ends up too scared to go out at all. But lo and behold: symptoms disappear if she starts taking Xanax.
Xanax (a/k/a alparzolam) belongs to the class of minor tranquilizers known as benzodiazepines. Compared with other classes of drugs used to treat panic, Xanax kicks in more quickly and produces fewer unpleasant side effects. Patients like Xanax and doctors share their gratification. But after several months, when the consensus is that patients should be weaned off the medication, they find out the bad news. They’re addicted. (Hereafter, the term “dependent” will be used. The psychiatric establishment reserves “addiction” to describe the behavior associated with obtaining illegal drugs.)
For some conditions, such as anxiety or TMJ (tempomandibular-joint pain, which is sometimes caused by muscle tightening), small amounts of Xanax are prescribed — two milligrams a day or less. But many panic patients need more than four milligrams of Xanax a day. On that dosage, they’re sure to become so dependent that if they stop medication abruptly, they might have a seizure and die. Even if they taper off slowly, withdrawal symptoms often persist for weeks. Experts recommend a strict tapering regimen that lasts months — but even then, panic symptoms may come back worse than ever.
Xanax isn’t the only way to treat panic. The best doctors tailor treatment to the individual, often using first medication and then “cognitive/behavioral” therapy, designed to help the patient analyze her or his fears and then confront them. And though research suggests that psychotherapy has a lower rate of relapse than drug therapy, Upjohn thinks medication works best.
The story begins in 1981, when Xanax was introduced. By 1987 the palindromic upstart had replaced Valium as America’s most prescribed tranquilizer. Soon afterward, clinical trials established Xanax as an effective treatment for panic disorder, and in 1990 the Food and Drug Administration (FDA) approved Xanax for panic patients.
In recent years Halcion and Xanax have accounted for almost half of Upjohn’s earnings. But as Halcion came under siege in 1991 for the unpredictable responses it provoked (think George Bush in Japan), Upjohn began to depend on Xanax. It raised the price of the drug by 10 percent last year, then again by nine percent this past February. This year revenues from the panic pill are expected to reach well over $600 million.
To maintain profits, Upjohn needs cheerleaders like Jerilyn Ross, president of the Anxiety Disorders Association of America (ADAA). Ross makes speeches encouraging panickers to seek treatment, and she recently appeared in a video news release paid for by Upjohn to push Xanax. (Video news releases are the TV equivalent of advertorials, promotional clips slickly produced to resemble the news.)
Of course, Ross needs Upjohn as well. Upjohn has contributed to the ADAA every year since 1984, and last year it bankrolled an ADAA opinion poll about panic.
In 1989 Upjohn gave $1.5 million to the American Psychiatric Association (APA), which used the “unrestricted” (i.e., “no string attached”) grant to produce educational videos about panic, anxiety, and depression.
“People don’t understand mental illness, and there’s a valid educational job to be done,” says John Blamphin, the APA’s director of public affairs. “On the other hand, Upjohn has medications for anxiety disorder and panic. The more people know about the illnesses and get into treatment, the more likely their [Upjohn’s] medications are going to be prescribed.”
When asked about Upjohn’s promotion of panic, company spokesman Godfrey Grant explained, “We’re trying to do something that is in our interest, but it is also a legitimate project to make the public more aware” of a disabling illness.
At the APA’s annual meeting this past May in Washington, DC, Upjohn’s self-interest was symbolized by a black Xanax sign on a pole. The sign revolved high above the convention-center floor, towering over exhibits for other over-hyped psychoactive drugs, such as Prozac and BuSpar. At the foot of the pole, Upjohn’s Panic Interactive Learning Center seated eight at a time. Curious visitors could don headphones and touch their personal video screen to active segments offering the medical overview, case histories, or physicians’ perspectives. Naturally, all the doctors urged medication for panic.
Upjohn wasn’t just hawking at the APA convention; it also funded a three-hour symposium, “Panic Disorder: Consensus for the ’90s.” Speakers included Dr. James Ballenger, of the Medical University of South Carolina, who declared that tranquilizer dependence is “probably the most controversial issue in psychiatry” today.
In a recent interview Ballenger blamed the uproar on media hysteria, claiming the benefits of Xanax as a treatment for panic usually outweigh the risks. “Patients hear things that unnecessarily scare them,” he intoned, “and they feel guilty about becoming dependent. But dependence is not a weakness. It’s a physiological condition.”
