An increase in the number of people taking antidepressants continued a trend seen since the late 1980's. In 1987, Prozac was approved for the treatment of depression. The medication was found to be more effective than previously prescribed medications. It also had fewer side effects. "Patients reported feeling 'better than well.' It not only eased their depression, but seemed to give them a new look at themselves."8 Within two years, 65,000 Prozac prescriptions a month were being filled. In 1987, 37% of depressive disorder patients were treated with antidepressants. By 1997, 75% of patients were taking antidepressants. During this time period, the percentage of patients receiving psychotherapy, however, went down (from 71% in 1987 to 60% in 1997). Are more doctors looking for the "quick fix" when it comes to depressive disorders? Are more patients?
"The imagery and symbolism in advertising and mass media sometimes suggest to patients that a specific medication promises to solve health and life problems in magical ways" (Montagne). From 1997 to 1998, Eli Lilly and Co., makers of Prozac, the most prescribed antidepressant, spent over $60 million in direct-to-consumer advertising for the drug. In 2000, the makers of Paxil, another antidepressant, spent over $92 million dollars to tout its benefits.
One antidepressive medication is also being marketed to those who do not have depressive disorders. In a controversial move, Eli Lilly started advertising a "new" medication for premenstrual dysphoric disorder (PMDD) in 2000. The ad campaign for Sarafem ("the first and only prescription medication for PMDD", according to the ads) claimed that the medication helps women who suffer from severe discomfort, mood swings, and tension every month.
Sales of the drug soared as 202,000 prescriptions were written from July 2000 to January 2001. Sarafem, however, was not new. It contained the same ingredient as Prozac. Critics claim that this was just a marketing ploy by the company to extend the profitability of its most popular drug9. Laura Miller, an Eli Lilly spokeswoman, defended the creation of the new brand of Prozac saying: "We asked women and physicians, and they told us that they wanted a treatment with its own identity. Women do not look at their symptoms as a depression, and PMDD is not depression but a separate clinical identity. Prozac is one of the more famous pharmaceutical trademarks and is closely associated with depression" (Vedantam). But, in 2002, second quarter sales for all brands of fluoxetine hydrochloride (two of which are Sarafem and Prozac) were down 72% from the second quarter of 2001. Eli Lilly blames the drop in sales on competition from generic forms of the drug. The importance of a "treatment with its own identity" may have been overstated.
And PMDD: Is it a real disorder? In the 1980s, the American Psychiatric Association (APA) considered listing PMDD as an official condition in its Diagnostic and Statistical Manual of Mental Disorders. Backlash from women's groups (fearing women's competence may be questioned in the workplace and in court rulings) led the APA to leave PMDD out of the Manual. "When men get mood shifts, no one says let's call it mental illness," said Paula Caplan, a PMDD critic who wrote the book They Say You're Crazy. But, many doctors argued that PMDD is a serious problem that interferes with women's lives. The disorder was put in the appendix of the APA Manual when the FDA approved Prozac to treat the condition. However, the debate still goes on. Speaking about the difficulty of distinguishing between PMDD and PMS10, Nada Stotland, a psychiatrist at Rush Medical College in Chicago said: "Unlike any other kind of psychiatric condition, most women believe they have PMS, and most people believe women have PMS. We now have a psychiatric disorder with [symptoms] that people believe all women have" (Vedantam).
Does this mean that more people will be taking this mood-altering drug?11 What about side effects? Besides the usual headache, drowsiness, and fatigue that almost any medication has a possibility of causing, more than 200 lawsuits have been filed against Eli Lilly claiming that Prozac (or Sarafem, or fluoxetine hydrochloride) causes suicide and violence. Most cases have been settled out of court, but in one case that went to court in 2000, the president of Eli Lilly's neuroscience product group testified under oath that there was no correlation between Prozac and suicidal thoughts and violence. The jury ruled in Eli Lilly's favor. Later that year, Eli Lilly decided to stop development of a new, improved version of Prozac. The patent for this new, improved version claimed that "it would reduce the 'usual adverse effects' of the original Prozac, including 'suicidal thoughts, self mutilation, [and] manic behavior'" (Huffington). When this was made public, a lawsuit was filed against the company charging fraud in the court case mentioned above.
All this did not slow sales for antidepressant drugs overall. The number of antidepressant prescriptions dispensed increased by 13.2% from 2000-2001, while the number of people diagnosed with depressive disorders increased by only 3.7%, suggesting that more people were being treated for other disorders with these drugs.
Ritalin has been controversial in recent years. It's used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). However, some have claimed that doctors are prescribing this drug to children who do not have ADHD. The next panel will discuss this issue in more depth.
Sources: Chart data: IMS Health. National Disease and Theraputic Index, 2002 and National Prescription Audit Plus, 2002. Retrieved July 18, 2002 from http://www.imshealth.org. Number of adults with depressive disorders extrapolated based on a figure of 9.5% of the population suffers from depressive disorders. Population data: "Projections of the Total Resident Population by 5-Year Age Groups, and Sex with Special Age Categories: Middle Series, 1999 to 2000." and "Projections of the Total Resident Population by 5- Year Age Groups, and Sex with Special Age Categories: Middle Series, 2001 to 2005. Retrieved from U.S. Census Bureau website at http://www.census.gov. Panel data: Richard Frank, et. al. The Henry J. Kaiser Family Foundataion. Trends in Direct-to-Consumer Advertising of Prescription Drugs, February 2002. Michael Montagne. "Patient Drug Information From Mass Media Sources." Psychiatric Times, May 2002. Retrieved July 18, 2002 from http://www.psychiatrictimes.com/massmedia.html. National Institute of Mental Health. "The Numbers Count: Mental Disorders in America." NIMH Publication No. 01-4584, January 2001. Retrieved July 18, 2002 from http://www.nimh.nih.gov/publicat/numbers.cfm. Nancy Schute. "Tripling Treatment." U.S. News & World Report, January 21, 2002. Retrieved July 18, 2002 from http://www.usnews.com/. Shankar Vedantam. "Renamed Prozac Fuels Women's Health Debate." Washington Post, April 29, 2001. Retrieved July 18, 2002 from http://www.washingtonpost.com. "FDA Panel Recommends Fluoxetine for PMDD." Psychiatric News, December 3, 1999. Retrieved July 19, 2002 from http://www.psych.org/pnews/99-12-03/pmdd.htm. Arianna Huffington. "Prozac: Unsafe At Any Price." Arianna Online, October 23, 2000. Retrieved July 19, 2002 from http://www.ariannaonline.com/columns/files/102300.html. Eli Lilly & Co. "Information for the Patient: Sarafem®." Retrieved July 18. 2002 from http://pi.lilly.com/us/sarafem.ppi.pdf. Pharmacy information retrieved from http://www.walgreens.com and http://www.drugstore.com. "Lilly Announces Second-Quarter Earnings Per Share of $.61." Lilly Newsroom, July 18, 2002. Retrieved July 19, 2002 from http://newsroom.lilly.com/news/.
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