From the debut of Prozac, in 1988, ten years before direct-to-consumer (DTC) drug advertising, one of the top performing drug categories was depression drugs. In fact the discovery that people with real life problems with their job, the economy and their family would term it "depression" sailed Pharma through the 1990s and 2000s. Unlike drugs like Valium and Librium which were taken as needed and which the new antidepressants replaced (because anxiety was now "really depression" according to Pharma messaging) the new antidepressants were taken every day, for years. Ka-ching.
Ten years after DTC advertising began, the number of Americans on antidepressants had already doubled to 27 million or 10 percent of the population (though almost 73 percent had no psychiatric diagnoses). Today as much as 25 percent of some U.S. demographics are on antidepressants. So many people are now on antidepressants, waterways themselves are swimming with the drugs from wastewater and fish are actually "on Prozac."
The weight gain, sexual dysfunction and bone thinning/fractures linked to antidepressants have been well publicized. But a 2010 JAMA article suggested that in most cases antidepressants don't even work. Other research suggests the drugs only work for a short time----though people are kept on them for years and even decades. (SSRI antidepressants also can trigger extreme and bizarre violence including mass shootings, knife attacks, suicide and even self-immolation.)
Faced with drugs that never work, stop working or patients who do not have depression to begin with, Pharma has rolled out a lucrative "add-on" marketing scheme. "Approximately 2 out of 3 people being treated for depression still have unresolved symptoms," it says. Pharma loves add-on campaigns because they triple its profits and few ask why they should take the first drug if it is not working. For example 100 pills of the brand name add-on drug Abilify cost $1,644 and 100 pills of the brand name add-on drug Invega cost $1,789. That's enough to make you depressed.
Other Ways To Sell Antidepressants
Pharma has other methods to prop up its depression franchise. If your first expensive drug followed by your second expensive drug doesn't work, maybe you have "treatment resistant depression!" Who's to say you don't? There is no blood test for depression. Let's add a third and fourth drug.
There is another trick to keep the antidepressant boat afloat. Before direct-to-consumer drug advertising, depression was considered to be a self-limiting disease----neither a lifelong condition or progressive. But now, Pharma, on the basis of no credible research, says depression is "progressive." Don't wait----you'll get worse says Pharma's unabashed scare campaign.
Here is how Vladimir Maletic, MD who served on Eli Lilly's Speaker's Bureau, puts it. "Depressive episodes become more easily triggered over time. 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." Does anyone need to be told that Eli Lilly makes a lot of antidepressants?
There is one more rung in Pharma's scheme of selling drugs that often don't work for a disease people often don't have. Programs for the poor. As Pharma's drug prices go up, it rolls out patient assistance programs or coupons to dodge the accusation of harming the poor. Yet the compassion pricing is merely public relations and cost shifting. Pharma still gets it five and six digit drugs paid for by taxpayers and by the premiums of the privately insured. Pharma's depression profits are...progressive.
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