No Exit Strategy

Dear Pristiq,

I know I shouldn’t blame you that your parents must have named you due to extraordinary proximity or ana-mana-pia to the word prestige.

I get it.

Pharmaceutical company birthed you in some effort to compete with the Wyeth family's Effexor XR. I suppose somebody got paid boo-koo bucks to spin your Robin hood like effort as reversing the stigma of depression. As in not merely helping but even going so far as to impart prestige in a world of mental health stigma. As in one might have prestige being on this drug. As in, look what we’re doing to help the depressed and anxious of the world—altruistic company that we obviously are.

Doing your part, little cash baby—only one hundred fifty dollars a month coming out of that small disability paycheck. 

I shouldn't blame you, that there is no exit strategy. That you only come in unbreakable, extended release tablets with your 11 hour half-life. Ready to ensure yo-yo symptoms in those who try to crawl out of your web with every other day dosing strategies.

There is no exit strategy.

But that’s not your fault. You’re just an enteric-coated baby released from the Pfizer mother-ship. I shouldn’t be angry that there is no smaller pill—no dosage available less than the 50 milligram suicidality inducing therapeutic dosage. I shouldn’t blame you that your mother tells us that we must taper the dosage to avoid withdrawal—I’m sorry, discontinuation syndrome side effects, when there is nothing smaller to taper to. No smaller pill has even been a twinkle in the mother-ship's eye. And then when the withdrawal effects manifest, pompous arguments can be made about depression relapse. When suicidal thoughts appear, fear motivation can be harnessed for further entrapment campaigns.

No. I shouldn’t blame you. You’re just the greed-powered-wind-up-doll-drug mechanically going through the motions, screwing patients on cue.    

most insincerely,

a physician