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Selling Depression

The discovery that many people with life problem or occasional bad moods would willingly dose themselves with antidepressants sailed the drug industry through the 2000s. A good chunk of the $4.5 billion a year direct-to-consumer advertising has been devoted to convincing people they don’t have problems with their job, the economy and their family, they have depression. Especially because depression can’t be diagnosed from a blood test.

Unfortunately, three things dried up the depression gravy train for the drug industry. Blockbusters went off patent and generics took off, antidepressants were linked with gory and unpredictable violence, especially in young users and — they didn’t even work, according to medical articles!

That’s when the drug industry began debuting the concept of “treatment resistant depression.” It wasn’t that their drugs didn’t work (or you didn’t have depression in the first place), you had “treatment resistant depression.” Your first expensive and dangerous drug needed to be coupled with more expensive and dangerous drugs because monotherapy, one drug alone, wasn’t doing the trick!

You’ve got to admire the drug industry’s audacity with this upsell strategy. Adding drugs to your treatment resistant depression triples its take, patients don’t know which drug is working so they’ll take all of them and the defective drugs are exonerated! (Because the problem is you.)

Now the drug industry has a new whisper campaign to keep the antidepressant boat afloat. Your depression is “progressive.”

Once upon a time, when depression was neither seasonal, atypical, bipolar or treatment resistant, it was considered to be a self-limiting disease. In fact, just about the only good thing you could say about depression was it wouldn’t last forever.

But now, the drug industry is giving depression the don’t-wait scare treatment like coronary events (statins), asthma attacks (“controller” drugs) and thinning bones (Sally Field). If you don’t hurry and take medication, your depression will get worse!

“Depressive episodes become more easily triggered over time,” floats an article on the physician Web site Medscape (flanked by ads for the antidepressant Pristiq.) “As the number of major depressive episodes increase, the risk for subsequent episodes is predicted more from the number of prior episodes and less from the occurrence of a recent life stress.” The article, unabashedly titled “Neurobiology of Depression: Major Depressive Disorder as a Progressive Illness,” is written by Vladimir Maletic who happens to have served on Eli Lilly’s Speaker’s Bureau, says the disclosure information, and whose co-authors are each employees and/or Lilly shareholders.

On WebMD, a sister site to Medscape, the depression sell is even less subtle. An article called Recognizing the Symptoms of Depression, smothered with five ads for the Eli Lilly antidepressant, Cymbalta, submits, “Most of us know about the emotional symptoms of depression. But you may not know that depression can be associated with many physical symptoms, too.”

Depression may masquerade as headaches, insomnia, fatigue, backache, dizziness, lightheadedness or appetite problems mongers the article. “You might feel queasy or nauseous. You might have diarrhea or become chronically constipated.” And here, you thought it was something you ate!

The danger with these symptoms says the article is that you would fail to diagnose yourself as suffering from a psychiatric problem and buy an over-the-counter drug like a normal person. “Because these symptoms occur with many conditions, many depressed people never get help, because they don’t know that their physical symptoms might be caused by depression. A lot of doctors miss the symptoms, too.”

But when head and backaches aren’t labeled as depression, the drug industry make no money and insurance rates could stop climbing from over-treatment with unnecessary, expensive and dangerous psychoactive drugs!

To prevent such goring of marketshare, the article (whose content was “selected and controlled by WebMD’s editorial staff and is funded by Lilly USA,” an original WebMD financial partner according to the Washington Post) counsels worry about physical symptoms. “Don’t assume they’ll go away on their own.” Symptoms may “need additional treatment” and “some antidepressants, such as Cymbalta and Effexor, may help with chronic pain, too.”

Before direct-to-consumer advertising, the health care system was devoted to preventing over-treatment and assuring patients they were probably okay. Who remembers “Take two aspirin and call me in the morning”? Now patients are assured they probably aren’t okay but probably have a progressive disease. Luckily their disease can be treated with progressive prescriptions from pharma.

Martha Rosenberg’s first book, tentatively titled Born with a Fritos Deficiency: How Flaks, Quacks and Hacks Pimp the Public Health, will be published by Amherst, New York-based Prometheus Books next year.

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Martha Rosenberg is an investigative health reporter. She is the author of  Born With A Junk Food Deficiency: How Flaks, Quacks and Hacks Pimp The Public Health (Prometheus).

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