From the debut of Prozac in 1988, ten years before direct-to-consumer (DTC) drug advertising began on TV, one of the top-performing drug categories was depression drugs. In fact, the discovery that people with real-life problems with their jobs, the economy, and their families would term it "depression" sailed Pharma through the 1990s and 2000s. Unlike "benzos" like Valium and Librium, the new antidepressants were taken every day, for years. While doctors were quick to put patients on them, they were notoriously hard to quit. (Drug companies called the symptoms "discontinuation syndrome"--on the street it would be called withdrawal.)
Ten years after DTC advertising began, the number of Americans on antidepressants had doubled to 27 million, or 10 percent of the population. During the same time period, the number of doctor visits where individuals were prescribed antidepressants even though they had no psychiatric diagnoses increased from 59.5 percent to 72.7 and accounted for four out of five antidepressant prescriptions. Who says advertising doesn't work? But the U.S. antidepressant market peaked in 2008 and has been declining by four percent every year since.
Why the disenchantment? Antidepressants caused weight gain. They caused sexual dysfunction. And they often quit working. "Prozac Poop-out" in which patients develop a tolerance to the antidepressants and they quit working surfaced in the medical and general press. "Prozac wears off within a year for about one-third of those who take it," said Harvard magazine.
Human nature might be a contributor to poop-out, too, said psychiatrist Phillip Sinaikin. "An antidepressant not working anymore is no different from getting used to anything that used to thrill us," said Sinaikin in an interview about his book Psychiatryland. "We buy our dream house with two bedrooms and a garage, and after a while it doesn't make us happy anymore, and we are eyeing the house with three bedrooms and a pool. Another example, of course, is falling in and out of love." Ineffective antidepressants and poop-out are no doubt the reason DTC ads began spinning the idea of "add-on" drugs and "treatment-resistant conditions."
But, even as America's love affair with antidepressants has leveled off (thanks in part to "poop-out") articles on drug sponsored web sites fight back. An article called "Depression: Recognizing the Physical Symptoms" on WebMD, for example says "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 you thought it was something you ate!
The danger with these symptoms, continues 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."
And a terrible thing happens when you don't call normal symptoms depression. Pharma doesn't make any money.