Author: Jeffrey Lacasse
Position: Ph.D. Candidate
Institution: Florida State University College of Social Work
E-mail: jeffreylacasse@comcast.net
Additional Authors: Jonathan Leo, Ph.D.
Submitted Date: May 02, 2006
Published Date: May 4, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

David Healy raises intriguing questions regarding the rapid increase in bipolar diagnoses and the use of 'mood-stabilizing' medications (1). Although this phenomenon is multifactorial, surely consumer advertising has played a role.

A widely disseminated advertising campaign for aripiprazole claimed that it worked in the brain 'like a thermostat to restore balance' (2). Interestingly, the Abilify product websites for schizophrenia and bipolar disorder both used this same exact phrase to describe the drug's mechanism of action.

Print advertisements promoting aripiprazole for bipolar disorder claimed: "When activity of key brain chemicals is too high, ABILIFY lowers it ... When activity of key brain chemicals is too low, ABILIFY raises it (3)."

Since the FDA-approved product label lists the mechanism of action as 'unknown' (4), this advertisement is debatable. It is further questionable whether the complexities of treating bipolar disorder (unknown etiology and well-known heterogeneity in response to treatment) are accurately portrayed as a reliable, mechanical thermostat. However, consumers are likely to find such advertisements compelling.

Regarding unipolar depression, we recently argued (5) that antidepressant manufacturers commonly advertise their products by claiming that depression is caused by a lack of serotonin and that SSRIs normalize this deficiency, a claim not congruent with the peer-reviewed literature or FDA-approved product labels. We have not received any academic objections to our article, but several prominent psychiatrists have affirmed our conclusions. For instance, Wayne Goodman, Chair of the FDA Psychopharmacological Advisory Committee, admitted that the serotonergic theory of depression is only a 'useful metaphor'- and one that he never uses within his own psychiatric practice (6).

The presentation of metaphorical explanations as scientific consensus in consumer advertising has not been publicly addressed by the relevant professional associations. In fact, we observe that a cooperative relationship exists between industry and even highly esteemed medical facilities: The Mayo Clinic Depression Website, sponsored by Wyeth Pharmaceuticals (makers of venlafaxine) explains the treatment of depression via the serotonin metaphor (7).

Such bioreductionistic and highly arguable advertisements for psychiatric treatments imply much about the disorder they are licensed for. As Dr. Healy suggests, consumers who view such advertisements are likely to characterize their problems in a manner congruent with industry promotion and to request well-advertised pharmaceuticals as treatment. At a bare minimum, increased medicalization will result; in some cases, disease-mongering may indeed be an appropriate characterization.

Such consumer advertising is only possible in the absence of vigorous government regulation (8) or outcry from professional associations. We hypothesize that their combined silence significantly contributes to the process of disease-mongering.

1. Healy, D (2006). The latest mania: Selling bipolar disorder. PLoS Med, 3(4): e185.
2. Abilify consumer advertising website [cached as of April 14, 2006].
3. Abilify consumer advertisement. People Magazine, November 28th, 2005. Available at http://www.dtca.net/Pics/...
4. Abilify prescribing information. Retrieved from on April 22nd, 2006.
5. Lacasse JR, Leo J (2005) Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Med 2(12): e392.
6. Television adverts for antidepressants cause anxiety. New Scientist 12 November 2005. Retrieved from http://www.newscientist.c...
mg18825252.500.html on April 22nd, 2006.
7. Mayo Clinic depression website (2006). Retrieved from http://www.mayoclinic.com...
/MM00660 on April 22, 2006
8. Mintzes, B (2006). Disease mongering in drug promotion: Do governments have a regulatory role? PLoS Med. 2006 Apr;3(4):e198.