Consumer advertising of psychiatric medications biases the public against nonpharmacological treatment.

In the United States, antidepressant medications are heavily promoted through direct-toconsumer advertising, which is regulated by the Food and Drug Administration (FDA). Advertisements for selective serotonin reuptake inhibitors frequently contain information inconsistent with the scientific evidence on the treatment of depression with antidepressants. The information presented serves to promote the use of antidepressants by biasing the public against nonpharmacological treatment of depression. While the FDA enforces regulations requiring fair and balanced presentation when comparing one medication to another, there appears to be no action taken against pharmaceutical companies that distort scientific evidence in order to disparage nonmedical approaches to depression. Keywords: consumer advertising; antidepressant; depression; psychotherapy; sertraline The United States is one of two countries in the world that permit direct-to-consumer advertising of prescription-only medications. (New Zealand is currently attempting to phase out such advertising.) Most Americans have become accustomed to having their prime-time television shows interrupted by commercials that advise them to request medications from their doctors that will treat their heartburn, allergies, or erectile dysfunction. Of specific interest to the readers of this journal, advertisements for psychiatric medications are becoming increasingly common. As part of its mission of protecting consumers, the U.S. Food and Drug Administration (FDA) is responsible for regulating consumer advertising. Advertisements are required to contain fair balance, disclose major side effects, and to "present information that is not inconsistent with the product label" (United States General Accounting Office, 2002). If manufacturers violate these rules, they may receive a warning letter from the FDA. For instance, Pfizer received such a letter for a recent Zoloft advertisement published in the New York Times without a required advisory warning of the link between suicide and selective serotonin reuptake inhibitors (SSRIs; Food and Drug Administration, 2005a). Unfortunately, there is a programmed bureaucratic delay between the identification of objectionable ads and the issuance of warning letters. This means that when pharmaceutical companies run ads that violate FDA regulations (which happens with great regularity), they often do not receive warning letters until after the advertising campaign has run its course. Direct-to-consumer advertising has received much attention of late, including sharp criticism from two books authored by physicians, Marcia Angell (former editor-in-chief of the New England journal of Medicine) and John Abramson (a clinical faculty member at Harvard University). They have pointed out that the popularity of some recent blockbuster drugs has been significantly driven by direct-to-consumer advertising, rather than any empirically demonstrated additional therapeutic utility (Abramson, 2004; Angell, 2004). In the case of Nexium, for instance, the result has been increased costs to consumers, as less costly medications exist that are nearly identical (Prilosec), and in most cases, just as effective. Drug manufacturers are under no obligation, however, to inform consumers that there are alternatives to their product available, even if they are less risky or costly. Indeed, it would be foolish of them to do so, if they are concerned about profit. The FDA regulations for consumer advertising do require that advertisements tread carefully when comparing their own product to that of a competitor. Before claiming that their prescription medication is superior to another, drug companies must have solid evidence. Claims made without such evidence will be classified as misleading and issued a FDA warning letter. For example, after AstraZeneca Pharmaceuticals disseminated a television ad claiming that its cholesterol-lowering drug, Crestor, was superior to other similar drugs, the FDA issued a warning letter (FDA, 2005b). …