Part of the reason for Celexa's success may indeed be Forest's incentive bonuses. "Forest has put more of the emphasis on the incentive side," says Mark Devlin, a former Forest drug rep who is now a national sales director. As a result, Forest reps have a higher "physician call rate" than other companies, he says, attempting to visit about twenty doctors a day and "actually getting in front of about ten." (Lilly's reps, for example, see about eight a day.) But Backer, his fellow rep, insists the "counter-detailing just helps create more noise about Celexa." The Forest drug reps were armed with plenty of "clinicals" to back up their claims, she says.

Like all drug reps, Celexa's bury doctors under a blizzard of trinkets bearing their logo -- umbrellas, clip boards, even Valentine's Day bouquets. "We kind of keep up with the Joneses as best we can," Devlin explains. "The pens, notepads, coffee mugs -- that is something that is expected and, quite frankly, appreciated. Doctors ask for it, and we do our best to give them what is expected."

Naturally, Forest reps provide the usual assortment of lectures, small group dinners, teleconferences, and "stipends" for speaking or participating. They also offer what are known as "clinical sidebars" where doctors can pick up dinner at a restaurant to take home to their families. "You can have reasonable entertainment, something that makes it attractive to attend," Devlin says.

Dr. Jon Mohrer, the internist from Forest Hills, Queens, is one busy doctor Celexa reps called on. "There is a constant barrage of drug reps in my life here, maybe five or six a day," he says. "My policy is not to see anybody." He says he doesn't accept their gifts or literature and relies on journals and the nonprofit Medical Letter to check out new drugs. But it is hard to say no completely. For one thing, he sometimes accepts the free samples to save his patients money. "Sometimes the drug reps will come up and say, 'Oh, thank you so much for prescribing my drug,' " he says. "It's really annoying."

Mohrer's staff, however, is of a different opinion. The reps cultivate the office staff in order to get closer to the doctor, and once again, the drug rep's principal weapon is a free lunch. "About once a month, I will let them come in and bring deli or pizza or something for the staff," Mohrer says. "They love it."

"What really annoyed me," says internist Robert Goodman, "was physicians' willingness to be bribed."

Mohrer says he even feels a little bit sorry for the drug reps, who sometimes seem like glorified delivery people, and he has occasionally accepted their invitations. "I could go to dinner every night with a different drug rep if I wanted to," he says. He and his wife recently attended a dinner cruise around Manhattan that featured an endocrinology lecture, and once they saw the play Rent with drug reps from Bristol Myers Squibb and their husbands. Until recently, Mohrer occasionally patronized "clinical sidebars," too, stopping by Pasta Lovers or a popular kosher Chinese place near his home to pick up dinner for his family. "My kids like the Chinese food," Mohrer says. "But I'm getting increasingly uncomfortable with it -- I told my kids we're not going to do it anymore, and they understand."

Some doctors appreciate the reps, but they won't say so openly. "The reps provide good information, and they are functioning in a system where that is how you sell medicine," says a Connecticut psychiatrist who recently took in a Crosby, Stills, Nash & Young concert with his Zoloft rep.

One Manhattan psychiatrist who also asked not to be named says she has "learned a ton from drug reps and from their educational programs." Sure, she says, they have taken her to fancy restaurants -- Daniel, Lespinasse, Windows on the World -- for talks or dinners with other psychiatrists to compare notes. "They have very respected speakers. You listen, and you either buy their case or you don't," she says. Her husband, another doctor, recently turned down an invitation to Acquavit because he felt it was a conflict of interest. "We missed a good meal," she says. "It was a conflict for him, but it wouldn't have been a conflict for me!"

Sometimes, drug reps provide valuable insights, she says. "My Pfizer rep is terrific and comes with a loose-leaf binder full of clippings from lots of reputable journals. She has done the research for me." The psychiatrist says she doesn't think marketing efforts make an undue difference. "Doctors just aren't that corruptible," she says.

She rarely prescribes Celexa. "I don't like it," she says. "In my experience, Celexa causes a lot more weight gain than some of the others, and jitters. I've had the same results three times in a row." Her Celexa rep recently supplied a study purporting to show less weight gain than another drug, but she wasn't convinced.

She and her husband recently spent a drug-company-sponsored educational weekend at a resort near Lake George in the Adirondacks. Most of their time was very agreeable -- good food, walks in the woods, canoeing -- and only a few hours were devoted to medicine.

Those few hours, however, nearly drove her husband into a rage. The experts on hand were addressing the virtues of calcium-channel blockers, a product for treating high blood pressure. He knew research shows that calcium-channel blockers are both more expensive and less effective than other treatments. As it happens, calcium-channel blockers are also the second most heavily marketed class of drug in the U.S., after antidepressants. "Of course marketing has an influence on prescribing!" the doctor says. "Why else would these calcium-channel blockers be so widely used?"

Inside the doctor's office, the Celexa reps' game is a kind of small-scale one-upmanship with the other antidepressants. For one thing, the reps emphasize that its side-effect profile is "cleaner" than Prozac's -- some tests suggest that Prozac made patients jittery, while Celexa didn't. And the reps can make a strong case that Celexa is less likely to interact with other drugs. Likewise, it leaves a patient's system more quickly than its rivals, which makes it easier to take a patient off the drug. Forest also elected to fix the drug's price about ten percent lower than its rivals -- a big selling point with insurers. Like other drug companies, Forest also constantly churns out new findings about its drug, to help the reps get back in the door. "Some physicians need to see fresh new information every time you come in there," says Devlin.