The pharmaceutical industry spent $4.3 billion on consumer-targeted prescription drug advertising in 2008 [1
]. Proponents of such advertising believe that it educates the public about treatment options and encourages consumers to talk to their doctors about their health concerns [2
]. Critics have argued that the true purpose of DTC advertising is to prompt patients to make brand-specific requests for prescription drugs, which leads to unnecessary prescribing and the potential for conflict in the doctor-patient relationship [3
]. Despite the intensity of the debate, and associated efforts to curtail DTC advertising via legislation at the state and federal levels [5
], little research has examined the specific issue of how the attitudes, beliefs and behaviors of individuals with depression are shaped by DTC antidepressant advertisements. This is surprising, for antidepressants are among the most prescribed drugs in the United States [6
]. U.S. sales for selective serotonin-reuptake inhibitors (SSRIs) and selective norepinephrine-receptive inhibitors (SSRIs) were $12.5 billion in 2005, and approximately $122 million was devoted to direct-to-consumer (DTC) antidepressant advertising in that year [7
The present study begins to address this gap in the literature using data from a survey of Internet peer-to-peer depression support group members. Such groups remain understudied [8
] despite the fact that a majority of Americans regularly use the Internet to investigate health matters [9
], and nearly 3 in 10 Internet users participate in online support groups organized around issues of health and well being [10
]. On Yahoo! Groups alone, there were 3782 groups in the “mental health disorders” category in September 2009. Since the use health support groups is increasing, and because doctors deal with such patients on a daily basis, peer-to-peer support groups represent a vanguard population in need of study.
We first explored the extent to which highly motivated members of a depression support group are aware of antidepressant advertisements. Public awareness of these advertisements is generally high [11
], but awareness of antidepressant advertisements among individuals with depression is understudied. Other than a survey which found that 85% of respondents with depression had seen Prozac advertisements, we know little about how closely individuals with depression attend to these advertisements [15
Second, we assessed perceptions of the educational value of antidepressant advertisements among individuals with a history of depression. Many observers have questioned the quality of information in DTC advertising generally [12
] and antidepressant advertisements specifically [19
]. Judgments of an advertisement's believability mediate people's responses to it [20
], including their willingness to talk with their physicians after seeing such an advertisement [11
]. Ours is the first investigation to assess the views of people with depression about the educational merit of antidepressant advertisements.
Third, we examined attitudes toward these advertisements among individuals with depression. Consumers have usually reported neutral to positive attitudes toward DTC advertising [13
]. Attitudes are important because people who are positively predisposed toward these advertisements are more willing to seek information about advertised medications, discuss these drugs with their physicians, and request prescriptions [14
Fourth, we assessed how individuals with depression have responded to antidepressant advertisements. Surveys have found that consumers request prescriptions after seeing DTC advertising [12
], including requests for antidepressants [32
]. Donahue and colleagues found that the initiation of antidepressant drug therapy was 32% higher when antidepressant advertising was most extensive [34
]. Unfortunately, these studies do not examine the varied ways in which these advertisements shape patients' information-seeking activities in the medical encounter and beyond.
Fifth, we investigated if antidepressant advertisements influence treatment preferences by framing depression as an outcome of a brain chemical imbalance, a prominent view in such advertisements [35
]. Our focus is not on the validity of the chemical imbalance explanation, which has been contested [37
]. Rather, we ask if exposure to these advertisements is associated with acceptance of the chemical imbalance account. People who subscribe to this explanation may feel that pharmacological treatment is necessary [38
], discouraging consideration of evidence-based psychotherapies [19
]. Antidepressant advertisements can affect the public's beliefs about depression [40
], but no study has examined how awareness of these advertisements is related to acceptance of the chemical imbalance model.