Recently a friend of mine posted on Facebook her shock at seeing an advertisement on television for an ‘antidepressant’. This started a bevvy of misinformed and, just quietly, some frighteningly stigmatising comments. Whilst unintentional, many of the people who responded either held a lot of self-stigma, probably encouraged by people incorrectly telling them that they “absolutely cannot ever get better without medication”, or because they believed the issue was unimportant.
This is an area I have a great deal of passion for based on personal experience as well as experience in the mental health industry, including working with drug companies. So I feel it is important to share my position here to try and break down some popular myths and misconceptions. So here goes…
Unfortunately, our current government passed unhelpful amendments to the “direct to consumer advertising of prescription medicines” (DTCA) legislation that allowed these advertisements to appear on our TV screens. The public had a chance to confront this back in 2006, but as often happens these consultation processes were hidden, so you wouldn’t know about them unless you sought them out.
At the time many people who responded to the proposed changes supported either a ban on DTCA and regulation of disease-state advertising, or a ban on DTCA and for-profit disease-state advertising. These people considered the overall health impact of DTCA to be negative. They felt the only effective way to regulate DTCA was to ban it, but their opinions weren’t enough, and as soon as the current government got elected, they passed the amendments.
We only started to see the trickle through a few years later, as sure enough these laws resulted in the ads you now see regularly on television.
Anyone who has been to the United States will have seen how blatant and misrepresentative DTCA is. The news is full of stories about “mad people” being the cause not (as is more true) the victims of harm, followed by sponsored ads suggesting all sorts of cures for our ills.
Turn on the TV in the United States and you are bombarded with advertisements for junk food, diets and pharmaceuticals. Yes, this is the majority advertising on every American screen, and you have to ask yourself why. The answer is that these huge industries can out-bid every other industry competing for advertising space by the sheer weight of their financial resources.
My main concern is that DTCA is considered by some people to be consumer information, so lets get this clear – it is not. The primary aim of DTCA is to sell a product, it is not a public service. If you believe this than you must also agree that McDonald’s advertising weight-watchers meals is an attempt to improve the health of the nation.
DTCA is presented in a slanted and emotive manner, playing down risks and enhancing benefits for vulnerable consumers. Antidepressant advertising is the worst of this, I would fully support advertising of signs and symptoms prompting you to go and see your doctor if you are worried, but to offer a little pill of hope to a very complicated and misunderstood condition will only further distress people for whom the “miracle pill” does not work.
Furthermore it dis-encourages clinicians from looking holistically at the experience of depression for a person. That means it stops them from coming up with a collaborative recovery plan which may or may not include pharmaceutical intervention, nutrition, exercise, hormonal balance, talking therapy, peer support, physical root causality, social determinants and other things that go towards creating or healing the cause. Looking at and supporting the bigger picture is more useful to long term and complete recovery than drugs alone.
SSRI’s (antidepressants) are so prevalent in our society that metabolites of the drugs passed through human urine are now evident in our waterways (Brooks et al., 2003; cited in Rachel Liebert, 2006, Mental illness) Yep, that’s right – you only need to turn on your tap to get a dose – so if this is the answer, why aren’t we all bouncing off the walls with happiness?
Now don’t get me wrong, I’m not saying that antidepressants and psycho-pharmaceuticals are necessarily bad, I know plenty of people for whom they play an important part of their recovery, but the important thing to remember is that they never form the whole picture of recovery. Recovery is a jigsaw puzzle of many different tools. Indeed, if these drugs are already as prevalent as being in our water table, do we really need advertising for them?
For most people it only takes a trip to the GP to be offered a funded pharmaceutical. Why do we not create a budget for advertising some of the other things that equally (or more-so) help improve mental health and wellbeing, but that people don’t know as much about, or are harder to access?! Or even better, create package of care funding where the money that goes into subsidising pharmaceuticals instead goes straight to the person, and their support team, to decide what might work for them as an individual.
What I’d like to see is a bill passed where a proportion of profits from multi nationals like Pharma and Fast Food have to go into national health promotion advertising on balanced perspectives and evidenced alternatives for long term, sustainable health.
Now DCTA is back on the political agenda and I am delighted to see that the Royal New Zealand College of General Practitioners recently published a position paper outlining the harm DTCA causes and advocating for its prohibition. You can read this position paper here – https://oldgp16.rnzcgp.org.nz/assets/New-website/Advocacy/Position-Statements/2017.03-DTCAPositionStatement.pdf
I hope all the medical colleges make similar public statements and that there is a transparent parliamentary process where we can speak from our lived experience.