Promoting Prozac Shift Of Advertising Lifts Hopes For Wider Treatment Of Depression

Happy 10th birthday, Prozac.

My, how you’ve grown.

Since it was approved by the Food and Drug Administration in 1987, the anti-depressant has been taken by 27 million people, including 17 million Americans.

But that’s not enough for Eli Lilly & Co., which has just introduced the first advertising campaign for its top-selling wonder drug to be aimed at consumers rather than doctors.

In launching a “Depression Hurts” ad blitz in 20 major magazines, Lilly is only trying to keep up with the competition. Over the past year, major drug companies have begun to abandon their moratorium on consumer advertising for anti-depressants and anti-anxiety drugs.

“I got my marriage back,” says the handwritten note, shown with two wedding rings and a handsome, embracing couple, in ads for the anti-depressant Effexor.

“Does your life have signs of persistent anxiety?” ask the ubiquitous ads for BuSpar, an anti-anxiety medication.

The multimillion-dollar hard sell for psychiatric drugs reflects a striking shift in attitudes toward mental illness.

Once a shadowy misfortune families hid as if it were shameful, depression is becoming just another slice of the health-care business. The ads trumpet the idea that anxiety and depression result from imbalances in brain biochemistry, not from character flaws.

But marketing and mental health still make an unsettling combination.

“On the one hand, I think it’s good the message is getting out that there are effective pharmaceuticals for psychiatric problems,” says Dr. Francis Mark Mondimore, a Charlotte, N.C., psychiatrist and author on depression.

“But it oversimplifies the problem. It reduces mental illness to a sort of allergy: ‘Take this pill and it will fix you right up.”’

Prozac’s ad, posing a stylized rain cloud symbolizing depression against a yellow sun on sky-blue background, declares, “Chances are someone you know is feeling sunny again because of it.”

For some, the notion that “sunny” should be the steady state of human feelings may conjure up Aldous Huxley’s 1932 novel “Brave New World.” Inhabitants of Huxley’s imagined future use a drug called soma to “take holidays from their black moods, or from the familiar annoyances of everyday life.”

Yet soma is “one of the most powerful instruments in the dictator’s armory.”

For now, most psychiatrists and mental health advocates express wary approval of the ad campaigns, hoping they will lure a larger number of depressed people into treatment. Experts say severe depression or long-lasting mild depression will be experienced by one in seven men and one in four women in their lives, yet many never seek help.

“Depression is the most commonly under-recognized, under-treated medical problem in the United States,” says Dr. Troy L. Thompson II, professor of psychiatry at Jefferson Medical College in Philadelphia. “So for public education and decreasing the stigma, these ads are very helpful.”

Thompson says half of all suicide victims had seen their primary-care doctor in the previous month.

“A lot of people come in and give their doctor one chance, and only one chance,” he says.

Nonspecialists are often reluctant to diagnose depression, which can produce symptoms ranging from insomnia to pelvic pain, Thompson says. But if a patient tipped off by an ad asks about anti-depressants, there’s a greater chance that lifesaving treatment will be given, he says.

“I don’t really have a lot of interest in the marketing of any pharmaceutical product,” says Michael M. Faenza, president of the National Mental Health Association. “But I’m blown away by how much work we have to do in educating the public. … From what I’ve seen, the corporations are careful to be accurate and to keep things in good taste.”

There are dissenters, however.

“I’m against it,” says Dr. Ivan K. Goldberg, a New York psychiatrist who maintains a World Wide Web page on depression and fears the ads will encourage “casual psychopharmacology” by inadequately trained doctors.

Of the Effexor marriage ad, he says, “I think that kind of emotional sell is not appropriate for a medical treatment.”

Depression is as old as human history. The Greeks blamed an excess of “black bile” or melas chole; hence the word “melancholy.”

Sufferers included the brooding Abraham Lincoln; Charles Darwin, who wrote of periods in which he was “inexpressibly gloomy and miserable”; and Winston Churchill, who spoke of his “black dog” moods.

Folk remedies for depression abounded, including St. John’s wort, an herb now enjoying a revival of interest.

Though alcohol is a depressant that can make matters worse, drink has long been used to dull the excruciating pain of depression.

Modern pharmaceutical remedies date only to the 1950s, when researchers in Europe and the United States stumbled onto compounds that could lift the spirits. The early anti-depressants changed millions of lives.

But they had troublesome side effects, and overdose could be fatal, a critical problem in suicidal patients.

The current generation of anti-depressants, developed in the 1980s, includes Prozac and its close chemical cousins Zoloft and Paxil. Called SSRIs, for selective serotonin reuptake inhibitors, all the drugs raise levels of the brain chemical serotonin, which is at low levels in depressed people. The SSRIs have fewer side effects than their predecessors, and overdose is not so dangerous.

Spending on advertising of all prescription drugs to the consumer soared from $55 million in 1991 to $595 million last year. But the companies hesitated to advertise psychiatric medication.

“Dealing with mental illness was a sensitive issue, with a lot of taboos,” says Doug Petkus of Wyeth-Ayerst Pharmaceuticals, maker of Effexor.

Effexor, the No. 4 anti-depressant, broke the ice with a test ad in 1995. It came back last fall with the marriage ads, as well as the slogans, “I got my brother back” and “I got my Mommy back.”

Now industry analysts predict rapid ad growth as the companies jostle for the business of untreated sufferers from depression.

Mondimore, the North Carolina psychiatrist, says he worries about marketing for tranquilizers and other drugs with high potential for abuse. But he is not disturbed that millions more Americans may end up on anti-depressants.

“I can only think it’s all to the good,” Mondimore says. “I mean, what’s been the effect of the polio vaccine? It’s cut health costs and eliminated a great deal of suffering.

“I really think the proper use of anti-depressants could have the same kind of impact.”