Prozac nacion: drug-maker Eli Lilly battles for hearts and minds in the Andes. (Marketing).

First, she maxed out her credit cards. Then, sleepless for days at a time, Gelma Zarate wandered Lima's streets, giving away her possessions and talking with supernatural beings. When she began university, the symptoms became so destructive that her family checked her into a psychiatric hospital.

"They diagnosed me and started pumping me with medication," recalls Zarate, who suffers from bipolar disorder, commonly called manic depression, which causes its victims to ping-pong between deep depression and extreme elation.

Zarate's symptoms largely disappeared with heavy doses of lithium, but not without ravaging side effects, including nausea, fatigue, vomiting and a dulling of her ability to play guitar. Frustrated and physically deteriorating, she wondered what was worse, the disease or a lifetime of drugs.

That was 1985, before the 1990s wave of new, more effective mental health remedies. U.S. drug-manufacturer Eli Lilly is now heavily marketing its products in the Andean region. But overcoming culturally entrenched beliefs about mental illnesses--and their treatment--is a challenge.

Sales of mental illness blockbusters like Prozac, an anti-depressant, have powered Lilly's spectacular growth into a US$12 billion-revenue company. In the first nine months of 2002, the company sold $571 million worth of the medication, down 68% compared to the previous year from $1.7 billion. (Prozac's patent expired in the summer of 2001 and generics have eaten into profits.) Zyprexa, an anti-pychotic and rising star for the drug maker, rose 24% in the same period to $2.7 billion.

Not surprisingly, Lilly wants to transplant its U.S. success, where three-quarters of all anti-depressants are sold, to developing markets abroad.

The pharmaceutical giant is pushing into the Andean region now because countries have agreed to protect its patents--and to help promote education on mental illness's causes, says Elia King. head of operations for Bolivia, Colombia, Ecuador, Peru and Venezuela. "There has been a lack of attention paid to mentally ill patients in our countries for years and that is starting to change," says the 24-year veteran of Lilly's Peru office, which posts annual sales of $53 million in the $3.9 billion Andean prescription market.

Mass marketing, a big factor in any new drug's acceptance, is coming to the region, too. Doctors are showered with traditional promotions, including dinners, conferences and educational seminars. Publicity comes in all forms: Brand-name mental illness medications appear in comedy scripts and storylines on television while the Andean press has covered the arrival of anti-depressants in relatively uncritical terms.

A star is born. In the case of Prozac, marketing paid off in the United States. The drug had a culturally transforming effect on U.S. patients, prompting many to drop psychotherapy in favor of the pill. In the 1990s, physicians and psychiatrists found themselves bombarded with requests after their patients saw television and magazine ads offering an end to depression.

Lilly wasn't alone. Swiss pharmaceutical maker Roche, for example, was so effective in marketing its anti-anxiety pill Klonopin that psychiatrists in New York City still have difficulty prescribing the much cheaper, generic form called Clonazepam.

Critics charge that most consumers of drugs like Prozac don't need them. Pharmaceutical companies stand to make a lot of money by creating demand through marketing, says Mike Montagne, a professor of social pharmacy at Massachusetts College of Pharmacy & Health Sciences in Boston.

There is a direct correlation, for example, between the most-advertised and most-prescribed drugs, Montagne says. Bad times are good business, too. "After September 11, we saw an increase in anti-depressant prescriptions," he says.

A perfect market for anti-depressants, Montagne says, would be strife-ridden, demoralized country with lots of people who are depressed about their future. You don't have to look too far in the Andean region to find that.

Yet Lilly faces a strong foe--tradition. Many people simply don't believe that mental illness is caused by chemical imbalances in the brain, the very notion that pill companies are promoting. Instead, they see Andean folk healers, called curanderos or chamanes, who treat mental illness as a spiritual disease.

One of the best-known folk healers in Lima, El Chaman del Norte, operates from a poorly lit downtown Lima office crammed with spooky figurines. Like Lilly, El Chaman relies on marketing. A newspaper advertisement claims he can bring your spouse or lover back to you, break evil spells and cure rare diseases. He has his own television program, one that has helped him gain notoriety both in Peru and abroad.

For El Chaman, publicity is key, too. In scores of photos in his office, he is embraced by a range of celebrities, like Mexican pop singer Cristian Castro, Venezuelan salsa singer Oscar de Leon and rock guitarist Carlos Santana, all of whom he says have sought treatment and advice. In one, El Chaman shakes hands with Peruvian President Alejandro Toledo.

"We have hundreds of years of experience and tradition," says El Chaman. Doctors and drug companies, he says, "don't realize that there are evil spirits that can drive people insane:

Exorcism by rabbit. In Cuzco, folk healer Felicitas Moscoso ministers to visiting U.S. and. European vacationers en route to Machu Picchu. She combines group counseling with natural hallucinogens, such as a popular jungle brew called ayahuasca, along with herbal massages and baths. "We look for what's causing the problem and do whatever it takes for the patient to feel better," says Moscoso, who claims that the companies don't sell cures but drugs that "block human emotions and turn people into robots."

Sickened by the lithium and frustrated about her condition, Gelma Zarate, now 39, once headed south of Lima to see a folk healer near the city of Ica. Treatment there included herbal massages, counseling and rubbing rabbits all over the young woman's body, purportedly to absorb evil spirits. Zarate saw the rabbits dying shortly after. "It was as if my illness had died with the rabbits," she says. "I felt great for a long time."

Lima psychiatrist Julio Flores says Zarate's improvement was the result of the power of suggestion. In Zarate's case, the remedy lasted a few months before her symptoms returned, forcing her back to harsh drugs. She finally quit treatment altogether. "I am sure that schizophrenia has nothing to do with spirits," says Flores, who prescribes Lilly's Zyprexa for bipolar disorder.

Still, folk healers fill an important role as counselor and trusted friend in their communities, says Roberto Zuloaga, head of psychiatry at Lima's Ricardo Palma Clinic. "The pueblo loves its curandero, so what do we gain out of making enemies?" says Zuloaga. "When my wife gets a cold, she buys traditional remedies instead of aspirin. The drug companies will not change that culture."

Some patients, too, can't afford the new medicines, Zuloaga says. A 20-milligram Prozac capsule that sells $3.20 in the United States costs $2.43 in Peru, a 24% discount but expensive nonetheless in a country where the average annual income is $2,100.

Yet, there are sick people who could benefit. Zarate might be a candidate for Zyprexa. She's been risking relapse out of fear of another pill-popping regimen but says she's open to hearing what the new drugs can do. Lilly's growth in the region will surely depend on reaching people like her.

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