I’ve written several posts in the past months in which I’ve highlighted the dramatic rise in diagnoses of mental illness in North America in the last 30 years. In addition to the rise in diagnoses, there are other related happenings that have been growing in significance, and I’ve also featured some of these in my posts. They include such things as the insurance payment structure in America lending itself to drug treatment over talk therapy and the growing list of disorders that is included with each new revision of the Diagnostic and Statistics Manual (DSM).
Pinning down exactly how these things (directly or indirectly) have a connection to the increase in mental illness diagnoses is undeniably complicated—perhaps impossible to prove—but I absolutely believe they are interrelated. There are even more factors in play than those about which I’ve written, and this post will touch on another: drug advertising.
Only two countries in the world allow direct-to-consumer advertising (DTC) for prescription drugs: New Zealand and the United States. Ads began in the U.S. in the 80s, but early FDA regulations stated that a drug company couldn’t state what the drug was for. Does anyone remember the old commercial that urged TV watchers to ‘ask your doctor if the purple pill is right for you’? The ad neither specified the ailment that the purple pill was intended to treat nor did it name the drug (answers: acid reflux and Nexium.) It was absurd! At the time, there were only a small number of TV ads and they were aimed at prescribers. Regulations changed in the late 90s and while the ads (thankfully) became less absurd, they exploded across our television screens and in print. Ads for antidepressants are no exception.
Drug companies advertise because it increases their bottom-line: every $1.00 spent advertising prescription drugs is estimated to increase their retail sales by $4.20 because consumers then go to their doctors and ask for those medications by name. Ethical considerations aside, it’s the customer who pays for the marketing, and drug prices in the United States are the most expensive in the world.
And then there are the ethical considerations. If a car commercial influences my car purchase decision (as Toyota did in the late 1990s with its use of the Todd Rundgren song Bang the Drum All Day in the RAV4 ad), and the car turns out to suck—which the RAV4 didn’t— that’s a lot different than a drug commercial potentially influencing my pursuit of medication.
A good start to a list of the pros and cons of drug advertising, including the ethical considerations, can be found on the ProCon.org Web site.
To me, one of the most interesting aspects of this issue is that only two countries in the world allow this kind of DTC advertising. Perhaps it’s not a red flag, but it’s a flag—purple, paisley or otherwise. (If I tell you that I think sometimes the U.S. Supreme Court’s rulings in favor of the Constitutional right to free speech don’t provide the necessary protections to its citizens will you think I’m a pinko Communist?)
A 2009 World Health Organization article states that pharmaceuticals have been under some pressure to rein in their U.S. advertising, and the FDA has felt similar pressure to strengthen its regulation. As a human being who is susceptible to advertising, I would like to see DTC advertising for prescription drugs go away altogether. The pharmaceutical companies already wield enough influence in this country. They don’t need a platform that gives them access to the hearts, minds and pocketbooks of consumers. Besides, I’m saving up for a set of Ginsu knives.
Rae Ellen Lee says
Laura
Glad to read this post. This topic needs to be aired and repeated (I say RT this post!). Long ago I tried to take anti-depressants but they made me feel worse than before. Same with alcohol. It’s one reason I’ve done a lot of talk therapy and over the years have learned to fine-tune the old sense of humor. Thanks for writing this. Now to see if I can answer the math question below.
Rae Ellen
Mary Kathryn Johnson says
Good job on the “humor fine tuning!” I guess you got the math question right!
Laura Zera says
Thanks for sharing your experience, Rae Ellen. I think antidepressants are one of the most over-prescribed medications and applaud the doctors who encourage and support their patients in trying other modalities (unless the situation appears to be critical and/or the person is in crisis state — then I think that a medication could be a necessary first step). I am a huge fan of talk therapy — have used it a lot myself — but think that the commitment of time/money may scare people away. It doesn’t always provide results as quickly, but I think the results are more permanent.
Tess Hardwick says
Can’t tell you how many family members have suffered because of the “drug will cure all” approach to depression. Thanks for the great post.
Laura Zera says
Thanks, Tess. It does seem that people react with great degrees of variation to the medication, and then also sometimes don’t continue to work on what lies beneath the depression because they feel like they’ve treated it with the drugs. It usually goes deeper than that.
Mary Kathryn Johnson says
Brilliant, Laura ~
I’m not at all susceptible to the pharmaceutical advertising, because I feel so strongly that our country is totally drug dependent, and the doctors and pharmaceutical companies profit from keeping us so!
Consequently, when I was depressed I turned to Legos and my 3yo son to get me out of it…And (thank you Rae Ellen Lee) a healthy dose of humor mostly aimed at myself! http://www.marykathrynjohnson.com/1/post/2012/02/say-bump-1.html
The Ads should go away, and doctors should talk to their patients again! Otherwise, we can just visit a kiosk to get our drugs dispensed, and take doctors out of the equation.
Laura Zera says
It seems odd, but I read some anecdotes from doctors that patients do indeed come in asking for a drug based on the TV ad. I’d like to think that the person would put more emphasis on the consult and counsel of their doctor. That said, I may need to write another post about drug marketing to doctors and how that influences them!
Humor is definitely a big help. When I started feeling glum at the start of winter, I made a decision to try and only watch funny movies. The dark dramas can go in my Netflix queue for summer. 🙂
Thanks for your comment!
Jo VonBargen says
Important post, Laura…thank you! Our society is overrun with drugs, to the point they’re even showing up in urban water supplies from being flushed down toilets in mass quantities! There are so many herbal remedies from which to choose, if only one takes the time to research a little bit.
Laura Zera says
Yes, isn’t that horrid?! Definitely a nasty by-product. In addition to herbal remedies, there are also vitamin supplements that have been shown to help with depression — Omega 3 fatty acids (fish oil) and folic acid, to name two. Oh, and Vitamin D, especially for those of us living in the Northwest. Supplements and herbs will work wonderfully for some, and some will do better with antidepressants, but usually knowledge about the herbal treatments comes from the person’s own research and not the medical profession.
Jodi Lobozzo Aman says
I wrote an article in the fall about how to decide to drug your children, i might edit it into a pillar post and try to submit it to some places. This needs to be spoken about. Did you ever read, Crazy Like Us by Ethan Watters?
http://healnowandforever.net/2011/08/10/on-deciding-to-drug-your-children-or-yourself/
Christina Carson says
This topic needed airing. This culture is giving itself over to chemical cures which touch only symptoms, not root cause. Well done, Laura. Thank you.
Laura Zera says
And thank you, Christina. I appreciate your support.
Andrew Kincaid says
I’m skeptical of these drugs being prescribed as often as they are, when oftentimes practical lifestyle changes might be better and would certainly be less dangerous. I believe, for philosophical reasons, that we should avoid all mind altering drugs unless there is a clear medical reason for their use. For example, if someone is schizophrenic or otherwise suffers from psychosis definitely needs to be medicated for their own safety – talk therapy is definitely a part of the equation, but medication is necessary. However, depression and anxiety shouldn’t always require a pill. I have had my own problems with those types of disorders (undiagnosed) but with my friend’s help and through spiritual practice I have learned to control them. Those may not be solutions that everyone can employ, but at the very least we shouldn’t be so quick to turn to medication.
What bothers me is that a general practitioner can prescribe a psychiatric drug, if someone comes in and tells them they have anxiety. It is literally that easy. There is no therapy, and no official diagnosis – a powerful, mind altering drug is prescribed just like an antibiotic would be prescribed. Does this seem reasonable to anyone?
Laura Zera says
Thanks, Andrew. You’ve given a very balanced perspective. I do actually have concerns about the ease with which GPs prescribe psychotropic medication. It seems a very nonchalant culture around their use, and yet the meds can have some powerful, life-altering side effects sometimes. What’s really needed is a close relationship between the patient and the doctor so that their is adequate follow-up and monitoring. I wonder how often GPs refer their patients to psychiatrists instead of writing a prescription themselves?
Becky says
Thanks for this post, Laura. I have been in “remission” since 2006 for problems related to anxiety and mood, thanks to three factors: medication, lifestyle changes, and talk therapies. I feel fortunate to have had great insurance and access to careful doctors and therapists. In my case, medication and non-medication strategies were symbiotic. Medication helped me with compliance, and therapy helped me “stick out” the side effects of the medications, and also the reality that it takes a while (months or even years) to find the right medication dose or the right combinations. In my case, a combination of healthful lifestyle choices and medication management have deeply helped me.
Laura Zera says
Becky, congratulations on making those changes and keeping the problems at bay! I appreciate that you shared this and am glad to hear that you found the right combination of strategies that work for you, plus good insurance and careful doctors — it’s a great example of a successful approach that has the right underlying foundation to support it.
Chris James says
Very informative post Laura, thanks. Although these issues don’t affect me directly, it’s excellent that people are talking about. The whole prospect of advertising pescription drugs horrifies, but then that shows the power of the Drug lobby in the US I suppose.
Laura Zera says
It’s interesting to hear that perspective from someone in a country that doesn’t allow drug advertising, as I think that over here, people have become used to it and don’t think of it as horrifying. Thanks for stopping by, Chris.
Jo-Anne says
Hi dear Laura,
I didn’t read all the comments but it looks like I will be in the minority – still, thought I would add my voice. Although I am all for talk therapy (ALL for it) and lifestyle changes, there are instances when the only way to those therapies actually working is if anti-depressants are used first or in conjunction with. Depression isn’t a matter of having the blues, the ups and downs of life or temporary angst or melancholy. Depression is a constant presence of an overwhelming, crushing sense of nothingness. I know, I went for years using all my energy to pretend during the day and then crawl into bed as soon as I got home to wait out the hours before I had to do it all again. I was finally lucky enough to have someone encourage me to seek out medical intervention. I thank God that I found that life line. The prescription did not give me a false glee or giddiness, it gave me the opportunity to actually address longstanding issues I could never have talked about otherwise. Chemical imbalance is of course part of bipolar illness but I believe it is a part of depression also. I think we need to be careful not to judge the illness nor the treatment that individuals decide, with medical consultation, are necessary in their particular circumstances.
Laura Zera says
Hi Jo-Anne, thank you for sharing your experience, and I actually don’t think that what you’re saying is too different from the overall sentiment here (my post and many of the comments). I hope that it doesn’t sound like I’m judging the treatment — I agree completely with what you’ve said. When I write about mental illness, I try to raise what I think are problems with the industry, e.g. drug advertising in the U.S., the huge growth in prescriptions (for people of all ages, including kids), the close relationship between pharma and psychiatry (e.g. the doctors who write the DSM are often also paid consultants of pharma), etc. My overarching concern is that the structure of the pharmaceutical industry combined with the private insurance industry (referring to the U.S. again) has lent itself to favor drug therapy too heavily. I do believe that antidepressants have become over-prescribed, and maybe that in itself holds some judgment of the treatment, I guess. If that bleeds over or can be perceived as judgment of the consumer, then I need to consider how I’m communicating my opinions. The last thing I want is to sound like I’m without empathy for those who experience mental health challenges or illness. Thank you again for your comment.
Rolando says
Thanks for the post Laura. It’s a fine line between defending individual freedom and allowing people to be manipulated, and it is not always easy to determine where to draw this line.
Laura Zera says
‘Tis a fine line, and I’d much rather leave the transmission of information and influence to doctors (who aren’t on the payroll of pharma) and ditch the pharmaceutical advertising. But that’s just me, and I like regulation more than others. Thanks for reading, Rolando.