Much attention has been cast on the relationships between clinical medicine and the pharmaceutical industries. How much has the pharmaceutical industry been influencing the treatment of depression and anxiety? The rate of use of prescription medication in the United States is higher than in other industrialized nations. The use of prescription antidepressant medication has drastically increased in the past 20 years. In fact, a 2007 study by the CDC found that in the United States, antidepressants were prescribed more often than medications for high blood pressure or high cholesterol! It is likely that the effects of direct-to-consumer pharmaceutical marketing, such as television and radio commercials, have played a very important role in the increased use of many patented antidepressant and anti-anxiety medications. These medications have been very profitable for pharmaceutical companies. In recent years, television commercials even advertise serious antipsychotic medication – even for use with depression – despite the fact that many in the field consider these drugs to be overused and to cause problematic side effects.
Succinctly stated by medical anthropologist Kalman Applbaum: “There is no doubt that drug company discoveries have profoundly improved upon our capacity to treat illness. But pharmaceutical marketing is more closely aligned with consumer marketing in other industries than with medicine, for which the consequences are not trivial. Once we view pharmaceutical industry activities in this light, we can disentangle industry’s influence on contemporary medicine.” – source article in PloS Medicne.
Implications of pharmaceutical marketing for mental health
What does this all mean for someone looking for help with anxiety or depression? Increasingly, when we look for information on how to get help, we are told about various drug options but are often not told that cognitive-behavioral therapy (CBT) is an equivalently effective option to medication (in most cases of depression and anxiety). For better or worse, there is not large corporate marketing machine spending billions annually to inform the public about cognitive-behavioral therapy. It is a proven treatment, and does not cause side effects like medications typically do. Moreover, the gains people make while in CBT are typically sustained after therapy is over; such a sustained post-treatment impact is not, however typical of antidepressant medication. The moral of the story here: be an informed consumer! Find out all effective options available for you, not just those endorsed by the pharmaceutical industry.
Biotech marketing and mental health
A recent parallel trend in mental health is that biotechnological interventions are also starting to be given a lot of marketing and publicity. For example, the recent direct-to-consumer publication of Lenox Hill Hospital / North Shore LIJ (a major medical center in New York City) entitled “In Good Health” has a headline on the cover “promising treatments for depression,” with a picture of a leaf, some tree bark, and what looks to be some sort of powdery herbal remedy. However, upon turning to the article, the reader is greeted by a five-column wide piece on deep brain stimulation, a relatively novel treatment for severe depression that uses electrical and magnetic energy to disrupt brain activity. In fairness, there is a one column-long story about herbal treatments on the far right – which is mostly an admonishment to consult your physician before taking herbal supplements. Nowhere to be found, in either article, is any mention of effective psychotherapies for depression such as cognitive-behavioral therapy.
Clinical treatment guidelines for depression suggest that for mild and moderate depression, an empirically-supported psychotherapy like CBT is part of good treatment. The NICE (National Institute for Health and Clinical Excellence, from the U.K.) guidelines for treatment of depression, for example, state that CBT should be at least a part of treatment for depression whether it is severe, moderate, or mild. While good providers follow these guidelines, hospitals, pharmaceutical companies, and biotech companies often feel little obligation to inform the public about options like CBT that are less profitable for them. It is unfortunate that many of the voices in American healthcare that inform consumers about available options do not emphasize safe, effective and noninvasive treatment options like CBT.
Getting informed: One good place to turn
You might be wondering where to turn for objective information. The National Institute of Mental Health is an excellent resource and is not funded by the pharmaceutical or biotech industries — only by our tax dollars. Their website states that “Some people with depression may be successfully treated with CBT only. Others may need both CBT and medication. CBT helps people with depression restructure negative thought patterns. Doing so helps people interpret their environment and interactions with others in a positive and realistic way. It may also help a person recognize things that may be contributing to the depression and help him or her change behaviors that may be making the depression worse.”
In healthcare decisions as in life, there is no substitute for being informed!