Anti-Depressants- How I Gained My Weight

abellone7289

Sometimes it is the medication and sometimes it is the depression/anxiety that makes you gain weight. Weight gain is listed as a side effect for many anti-depressants because it can slow down your metabolism.

My brother and my father both suffer from depression. My brother also suffers from anxiety, so he takes a lot of different medications. His symptoms are well managed with Zoloft but lately his doctor has been trying to tweak his meds to get them just right so he can concentrate better and such. For example he gain a some weight when he started taking abilify but he said it didn't make him feel any different, so a month and half later he was off it. Then he started taking zyprexa. Holy Crap. He gained about 35 pounds in 2 months. I didn't even recognize him. He had always been so fit and now he had a double chin!

Now my brother is young and super super active. He chops wood for fun- that kind of active. In those few months, he said he felt the same, no major life events happened to effect his depression and his diet and activity did not change one bit. But he probably gained a total of 50 pounds. And no joke, within 2 months of stopping the zyprexa all that weight was gone. Every pound. Now he's as fit as ever.

On the other hand my dad has taken zyprexa as well and didn't gain a pound while he was on it.

If you look into it, some antidepressants are have side effects of weight gain (like abilify and zyprexa). These drugs are often prescribed with metformin, which is a diabetes medication (which my brother took with both drugs) because it is known to cause weight gain that can lead to diabetes. On the other hand wellbutrin lists weight loss as a side effect.

It all depends on the person and there body chemistry and the way all that relates to the drug. That's why there are so many out there. Even though they are the same class of drug, they react differently with the body, and not just on the weight gain/loss level. Zoloft works like a charm for managing my brother's depression, but prozac made him hallucinate and landed him in the hospital.

What it comes down to is if you don't like what you are on, talk to your doctor. There are many options out there and your doctor should be able to work with you to find the best meds, or combination of meds, for you. Believe me, this is an ongoing battle in my home, trying to get it working just right for both my dad and brother. It can be done!

jillybean9881

I would like to contribute with my experience. I have been prescribed anti-depression medication on and off since 2000. Latterly, I have also had treatment for cancer (twice) ; the depression became worse. As the depression worsened, then the weight increased too. I agree that a life-change is the very best solution, to a happier mood, and contentment. However, we all know that there are many roads between a state of depression and a great life. Not all of us have the strength or capacity to stay on the "right" path, and our lives get diverted along the way.

I was lucky to be referred for Cognitive Behavioural Therapy (CBT) by my GP. Six months later, I am still taking anti-depressants, but the therapy has helped so much. My mood is great, I feel strong and able to control my eating. I have lost 7 pounds in the last 4 weeks.

Despite anti-depression medication (it isn't a "cure"), I was still deeply depressed and lacked motivation to do even the most basic of things. It has only been though CBT that I have been able to see the way through to taking care of myself. It has taken a long time, and the CBT has made me stop and take stock and realise that I have to be patient and take things step by step.

As a solution to weight gain, chucking out the pills, and changing your life is too simplistic. It is a whole lot more complicated. If you are suffering from depression, take time, take care and be patient with yourself - and good luck.

Therapy helped for me, too, during a very tough period in my life. I truly believe that medication only works to its fullest potential when it's coupled with therapy.

ili_s

I'm just wondering about the natural anti-depressant drug known as exercise. Does that at all help? have any of you experienced feeling better through exercising?

I've never been chronically depressed but I imagine that getting up to exercise would be virtually impossible in the really chronic phases. But I'm just wondering about the effects of it when one isn't as depressed anymore. Is it a good way to start weening oneself off the drugs?

yesthistime

Man, this thread was painful to read! Mental health professional here, and I finally understand how the health/fitness experts on this site must feel when they read gross misinformation about their fields on the message board.

I kind of want to give up my license and start teaching beach yoga instead. Much less controversial.

everytree

To be honest - this thread scares the crud out of me.

Please DON'T EVER stop your antidepressants without the help of a medical professional. Some need to be tapered off or cardiac or neurological "events" can occur. Yes, your heart can stop or you can start seizing, etc.

Do NOT take the advice of anyone on this thread to get off them without consulting with your medical professionals.

That being said....some medications do cause weight gain. No questions asked and it has nothing to do with lifestyle changes. Applies to all medications, not just anti-depressants either.

Please don't judge people who say they have gained weight from taking a medication, any medication. It can happen. For some meds - its a given it will happen. Some its just a chance and for some its a very rare side effect.

People who need to be on these meds are feeling bad enough and don't need to be judged when they say it caused them to gain weight.

Okay, stepping off my soap box now.

Sublog

Antidepressants don't make you fat. Over eating does.

Antidepressants change your appetite and your metabolism. Thank you for your incredible insensitivity.

Which goes back to my VERY VALID POINT.

Thanks for agreeing with me. I NEVER said that anti-depressants won't change your appetite, habits, lifestyle, and even RMR, HOWEVER, my stance is true.

YummyTpn

I'm just wondering about the natural anti-depressant drug known as exercise. Does that at all help? have any of you experienced feeling better through exercising?

I've never been chronically depressed but I imagine that getting up to exercise would be virtually impossible in the really chronic phases. But I'm just wondering about the effects of it when one isn't as depressed anymore. Is it a good way to start weening oneself off the drugs?

Speaking from experience and professionally, exercise is a HUGE antidepressant.

You are correct though, for somepeople who can't even get out of bed, speak, eat, or function in any way...exercise isn't going to happen.

The caveat is that depression largely affects motivation, so to get motivated enough to exercise is a huge hurdle for most.

Exercise inevitably helps someone with depression feel better because it increases the "feel-good" chemicals in the brain/bloodstream.

However, the medication issue is separate from the exercise. It doesn't work that way...you don't exercise, feel great, and then wean yourself off meds. It's much more complicated and individual than that. As I've stated before, medication is often needed long-term, even when someone is feeling well. They often feel well because of the medication, as well as other factors, such as therapy, diet, exercise...the list is different for each person.

wolfi622

Different anti-depressants work in different ways. A well documented side effect of Wellbutrin, for example is decreased appetite and weight loss.

lesleyls

Yup, I've been taking antidepressants for years and switching to paxil really messed me up, then when I switched to cymbalta, I didn't gain anymore, but I couldn't lose the weight, no matter how hard I tried. Once I tapered off, my weight slowly went down, I feel great being off of them, and take herbal supplements instead. Anyway, if I skip a dose of my herbals there are no fatal side affects that are potential when you skip a dose of a pharmaceutical. Good for you!

Curious about how you tapered off of Cymbalta. Ive taken it for 4 or 5 years and I get horrible withdrawal symptoms when I lower my dose. Did this happen to you?

kimbsh01

Antidepressants don't make you fat. Over eating does.

Beg to differ. I led a healthy lifestyle as far as eating.

seroquel will make u fat...thats a fact

kimbsh01

To be honest - this thread scares the crud out of me.

Please DON'T EVER stop your antidepressants without the help of a medical professional. Some need to be tapered off or cardiac or neurological "events" can occur. Yes, your heart can stop or you can start seizing, etc.

Do NOT take the advice of anyone on this thread to get off them without consulting with your medical professionals.

That being said....some medications do cause weight gain. No questions asked and it has nothing to do with lifestyle changes. Applies to all medications, not just anti-depressants either.

Please don't judge people who say they have gained weight from taking a medication, any medication. It can happen. For some meds - its a given it will happen. Some its just a chance and for some its a very rare side effect.

People who need to be on these meds are feeling bad enough and don't need to be judged when they say it caused them to gain weight.

Okay, stepping off my soap box now.

THIS!!

kbmnurse

Antidepressants are just a bandaid for the problem. All that crap is not good for you. Suck it up.

Nansweetnan

Amen sister..people who've not experienced depression & these meds, don't have a clue.

BeautyFromPain

lexapro was the same for me

Nansweetnan

You don't have a clue. Some pp. like myself need them to function or I'm a raving lunatic..no sleep, crazy ramblings...you have no idea what kind of hell a person like me or anyone else w/ mental illness goes through. You can't just suck it up, it's insensitive pp. like you that make people who are mentally ill feel stigmatized. Get some education and stop being so mean.

BeautyFromPain

Antidepressants are just a bandaid for the problem. All that crap is not good for you. Suck it up.

Depression is a imbalance in the brain. Just as you'd give medicine to someone with cancer you'd give it to someone with depression. It's not that easy.

lesleyls

...I feel great being off of them, and take herbal supplements instead. Anyway, if I skip a dose of my herbals there are no fatal side affects that are potential when you skip a dose of a pharmaceutical.

1) Your herbal supplements aren't even fully evaluated for safety, let alone effectiveness. People think that because things are "natural" they're safe. Arsenic, cyanide, and a whole host of other things are also "natural." There are plenty of problems with the FDA approval process in the U.S., but it is more rigorous than what "natural supplements" go through.
2) There are very few pharmaceuticals that can cause fatal side effects if you miss a dose. Those that do are likely to only be prescribed as a last resort or because they are the only available treatment for a very serious disease. I've been on a lot of anti-depressants (over the course of 2 decades now), and few of them came with that sort of side effect. The truth is, you have a better chance of getting killed in a motor-vehicle accident than by the vast majority of modern anti-depressants.

I beg to differ on #2. I'm currently taking Cymbalta and although the side effect may not be fatal, its feels pretty damn close. If I miss a does I get brain shocks, nausea, and extreme mood swings, like bad enough where I want to kill someone. So I consider that to be pretty fatal.

wackicatt

I was on welbutrin for years and lost a bunch of weight. Just recently I stopped taking my anti depressants and gained 14lbs in a matter of minutes......lol, I am laughing but it was horrible. I am happy to be off of them, now I have to drop these 14lbs on top of my extra 20lbs..... But we are going to be this! My best,cat

amyw615

I also gained a good 20 pounds after taking cymbalta. It helped with my depression (suffered a heart attack) but am having a hard time weaning myself off of it and losing the weight. Now I am depressed because of the weight!! It's a vicious circle!!!

BeautyFromPain

I'm just wondering about the natural anti-depressant drug known as exercise. Does that at all help? have any of you experienced feeling better through exercising?

I've never been chronically depressed but I imagine that getting up to exercise would be virtually impossible in the really chronic phases. But I'm just wondering about the effects of it when one isn't as depressed anymore. Is it a good way to start weening oneself off the drugs?

I have completely come off my antidepressants through exercise, this may not be the case for everyone. But was for me.

Amy_Lee_2012

If I listened to every half-wit who told me to 'suck it up', I would be dead. In fact, a failed attempt at suicide is what got me on antidepressants and that saved my life.
It is highly insensitive and, quite frankly, ignorant to tell people with a mental illness to 'suck it up' or 'get over it'.
My favorite one is when someone tells me- "it's all in your head" Yeah! No kidding, genius, that's why it's called a MENTAL illness.

I will never understand why some people can't get that depression, mental illnesses and disorders are just as serious and real as a physical illness...and..just like a physical illness, medication is often required. You can't just wish an illness away. If it were that easy, no one would ever be sick.

2April

My advice, you don't have to take it or agree with it, try to change your life without taking these drugs unless you absolutely have to. This is one of those cure is worse than the disease situations.

I agree. I think taking it for a short time is ok, but try and get off it as soon as possible. Side affects are horrible. Good luck!

If you have ever been TRULY depressed, you wouldn't say things like "go off your meds" so lightly. For some people, not being on their meds is a death sentence! This really is an area where if you are not qualified and don't have their personal medical records in your hands, you probably should not being saying such things because "someone" out there may take your advice and end up dead. I wouldn't want that on my shoulders!

After my sister was murdered, it took a month to find the body. Afterwards I locked myself in the basement for a long time and used empty pop bottles to pee in, so believe me, I know what it's like to be truly depressed and I do not take it lightly.

I'm sorry about your sister.
I agree that antidepressants should be avoided. I can't believe doctors hand them out like candy and people take them like they are the missing piece of the puzzle. Depression and sadness are a NORMAL part of life. These drugs exist to make people money, not to make people feel better. I resent that they are being taken in such high numbers that they are found in our drinking water and are doing untold damage to marine life.

Please read and comment on the following article.

Yale J Biol Med. 2012 March; 85(1): 153–158.
Published online 2012 March 29.
PMCID: PMC3313530
Copyright ©2012, Yale Journal of Biology and Medicine
Antidepressants and Advertising: Psychopharmaceuticals in Crisis
Nathan P. Greenslit, PhDa* and Ted J. Kaptchukb
aHistory of Science Department, Harvard University, Cambridge, Massachusetts
bProgram in Placebo Studies, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*To whom all correspondence should be addressed: Nathan P. Greenslit, PhD, Harvard University, History of Science Department, 1 Oxford Street, Cambridge, MA 02118; Email: npg@media.mit.edu.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way.
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Abstract
As the efficacy and science of psychopharmaceuticals has become increasingly uncertain, marketing of these drugs to both physicians and consumers continues to a central part of a multi-billion dollar per year industry in the United States. We explore how such drug marketing portrays idealized scientific relationships between psychopharmaceuticals and depression; how multiple stakeholders, including scientists, regulatory agencies, and patient advocacy groups, negotiate neurobiological explanations of mental illness; and how the placebo effect has become a critical issue in these debates, including the possible role of drug advertising to influence the placebo effect directly. We argue that if and how antidepressants “work” is not a straightforward objective question, but rather a larger social contest involving scientific debate, the political history of the pharmaceutical industry, cultural discourses surrounding the role of drugs in society, and the interpretive flexibility of personal experience.
Keywords: direct-to-consumer advertising, advertising, antidepressants, placebo effect
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Introduction
Psychopharmaceuticals are currently in crisis, and the science of depression has become a contest between scientists, pharmaceutical marketing, physicians, professional medical organizations, regulatory agencies, and patients. Public controversies and medical uncertainties concerning antidepressants have become the norm [1,2,3]. Since direct-to-consumer (DTC†) advertising was approved by the FDA in 1997 [4], pharmaceutical companies have been accused of exaggerating claims of drug efficacy [5], downplaying the health risks of antidepressant use [6,7,8], and hiding behind smokescreen public relations slogans of medical “awareness campaigns,” while slyly growing drug markets by over-medicalizing everyday experiences such as sadness, anxiety, and shyness [9,10]. In this controversial arena, the science of antidepressants has become uncertain, and physicians, policymakers, and consumers are left with few brute facts about if and how antidepressants work. Yet physicians want effective medicines, patients and policymakers want clarity of information, and pharmaceutical companies need to appear to be providing both. To provide a better understanding of the current predicament around psychopharmaceuticals, this article will look at three issues: 1) How pharmaceutical advertisements and professional marketing literature portray an idealized and simplistic relationship between medications and psychiatric illness; 2) how other stakeholders (patients, scientists, physicians, regulatory agencies, professional societies) accept or challenge a simple neurobiology of mental illness; and 3) how the placebo effect has become an increasingly important issue in these debates, including the new role of drug advertising to influence the placebo effect directly.
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Selling Science
Over the past decade, drug companies have launched extensive physician-directed and direct-to-consumer advertising campaigns to disseminate putative neuroscientific theories about mental illness. These ads are designed to convince doctors and patients that psychopharmaceuticals have an obvious, objective, and scientific relationship to the symptoms they are supposed to treat. Shortly after its FDA approval in 1987 [11], the first Prozac (fluoxetine) ads that appeared in medical journals claimed, “There is considerable evidence that serotonergic function may be reduced in the brains of depressed patients,” introducing Prozac as “a specifically-different antidepressant . . . Its distinctive chemistry means greater specificity.” The advertisement never claimed that Prozac would be any more efficacious than any other antidepressant. Rather, it focused on how the drug was chemically distinct from others, emphasizing that it had comparatively more specific action on neurochemical receptors. However, the rhetorical effect of using neuroscience in drug advertising is precisely to imply that pharmacological specificity translates into a more efficacious psychopharmaceutical. Since the original Prozac campaign, the medical image of psychopharmacological specificity has become increasingly fine-grained. A 2005 physician-directed ad for Remeron (mirtazapine) asked, “What’s the difference between SSRIs [selective serotonin reuptake inhibitors] and Remeron?” The answer: “SSRIs . . . Somewhat Selective; Remeron . . . Downright Picky. [Remeron offers] novel nonadrenergic and serotonergic pharmacological action.” This campaign capitalizes on the original “magic bullet” image of the SSRI, depicting how mirtazapine binds to a single subtype of the serotonin receptor. Just like the earlier Prozac ad, the Remeron ad does not promise greater efficacy, but rather more exact science.
Drug advertising seeks to fill in an explanatory gap between the bench science of psychopharmacology and the palpable or measurable real-world effects of antidepressants. While the pharmaceutical industry uses placebo-controlled clinical trials to establish that a given antidepressant is effective, these trials are neither designed nor intended to show why an antidepressant might work at all. Do patients experience symptom relief because their drug acts on a distinct underlying disease pathology (as pharmaceutical ads imply) or because their drug induces a psychoactive state (e.g., sedation, stimulation, or altered sense perception) [12]? There’s a lot at stake in deciding between these explanatory frameworks, since the science of mental illness and psychopharmaceuticals is contentious [13]. Not only do neuroscientists debate the most basic of biological mechanisms that may be involved in depression, but some recent analyses of clinical trial data suggest that, overall, SSRI antidepressants like Prozac and Effexor (venlafaxine) do not work much better than placebos [14,15,16]. Despite such broad uncertainty over both the scientific explanations and efficacy of antidepressants, DTC advertising is still a nearly 5 billion dollar per year industry (and practically unique to the United States, as no other country except New Zealand allows it) [17]. And antidepressants remain one of the most heavily advertised prescription drug categories [18].
Drug marketing gets recruited to do what science itself cannot: give meaning to scientific results. In an industry magazine editorial, one drug-marketing expert urged fellow marketers to “[t]ell the truth. Seriously, nothing sells like verisimilitude. Precise language and specific visuals, such as those that show the size of the pill, the mechanism of action or the genuine outcome of faithful compliance help create a reasonable semblance of ‘truth’” [19]. This marketer’s easy slippage from “truth” to “verisimilitude” to “reasonable semblance of truth” suggests that the very idea that neuroscience offers the truth of depression or anxiety is split between claims that the science is known and that it is unknown. In the middle is a rhetorical gray area of imputation, suggestion, and belief on the part of scientists, psychiatrists, and consumer-patients alike. In this middle comes the opportunity for companies to market the unknown to the Food and Drug Administration (FDA) and to the public, to repeat the possibility of neuroscience so that it becomes common sense.
The idea that neuroscience offers the “truth” of depression has gained remarkable popular culture cache in recent years, shaping our assumptions about the relationship between mind, body, and brain. One recent study concluded that neuroscience has a “seductive allure,” after showing that college students find theories of psychological phenomena more credible if they include neuroscientific terms, irrespective of whether neuroscience is actually relevant to the theories in question [20]. This finding resonates with how drug marketers reflect on their own advertising strategies: “Pharmaceutical companies need to realize that consumers do not care about your internal research. They do not ask for your drug because it is well researched. They ask because something you said in the 35 seconds made them interested. That is the end goal . . . Unfortunately, in the scientific world of drug companies, ‘I think’ is not allowed. ‘I know, I proved’ is the language rewarded” [21]. This quote comes from a 2002 article in the industry journal DTC Perspectives, published in the midst of the first DTC blitz. It warns that the drug advertisement development process should not mirror the drug development process. Since the advent of DTC, drug marketers have been honing how to give science market-driven meaning. Their professional literature encourages marketers to fantasize how to communicate to a market, before the drug is even developed: “This point is counter-intuitive to many companies. Doesn’t the science lead the way? Well, yes and no. Without the science, there is no product at all. But here’s what happens all too often with companies who overemphasize the science at the expense of the messages: they may develop very elegant answers to irrelevant questions” [22]. The article continues to explain how “market perceptions and needs” need to guide the science, not the other way around.
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A brief sociopolitical history of antidepressants
The science of psychopharmaceuticals is also contested by a variety of social groups, who fight over representations of neuroscience in advertising. On the one hand, patient advocacy groups have either embraced or resisted neuroscientific theories in drug advertising, depending on whether they interpret them as socially vindicating (biological explanations as exculpatory for stigmatized illnesses, such as premenstrual dysphoric disorder or post-traumatic stress disorder) or as socially constraining (biological explanations as oversimplified reductions of cultural or psychological complexity). On the other hand, advocacy groups, some including psychiatrists, have even filed complaints with the FDA and Federal Communications Commission (FCC), arguing that cartoons of SSRIs acting on neurochemical receptors (featured in Zoloft [sertraline] ads) are ultimately fraudulent claims about depression and its underlying biological pathology, because the science is still contentious. These controversies demonstrate what social scientists have observed concerning how seemingly objective things, like scientific fact, actually require a great deal of social work to be produced, circulated, and maintained.
Critiques over the neuroscience of antidepressants are caught up in larger sociomedical quandaries over what counts as proper medical uses of these drugs and how psychiatric illness should be defined and diagnosed in the first place. Early television commercials for Sarafem (fluoxetine hydrochloride, previously marketed as Prozac, which, at the time, had just gone off-patent) for premenstrual dysphoric disorder (PMDD) depicted frustrated women looking for lost car keys or trying to extract shopping carts at grocery stores. The FDA criticized these ads for not clearly distinguishing between PMDD and premenstrual syndrome (PMS) and for “trivializing the seriousness of PMDD.” The increased regulatory scrutiny over DTC has made pharmaceutical companies more strategic in how they tow the line. As one marketer put it: “Ad agencies have to be more creative than ever to create truly effective communications that are also responsible and do not overpromise” [23].
The current debates over the science, marketing, and uses of antidepressants are born out of a unique history of the role of drug therapy in psychiatric medicine [24]. Historically, American psychiatry has been at the center of broader social tensions between mainstream social institutions, countercultural movements, and civil rights. In the 1960s and 1970s, antipsychiatry groups challenged the cultural authority of organized medicine, especially psychiatry, arguing that it was an institution of social control. During this time, licit psychopharmaceuticals were vilified as “chemical straightjackets,” while illicit drugs that could only be obtained without a physician's blessing were celebrated as countercultural expressions of pleasure, mind expansion, and self-exploration, as epitomized by people like Ken Kesey and Timothy Leary. Benzodiazepines (such as Valium and Miltown) were the first psychiatric drugs to occupy a social middle ground between the two perceptions; they were prescription medications for the treatment of anxiety, but they were also pleasurable and consumed recreationally. But by the 1980s, prominent American media outlets, including The New York Times, were reporting that Valium was overprescribed and overconsumed and that people were becoming addicted to the drug. The sociomedical boundary of licit versus illicit got blurred in both directions.
Ever since the scandals surrounding the (mis)uses of benzodiazepines, the pharmaceutical industry has been deeply invested in the legal distinction between licit and illicit drugs, with its accompanying discourses of health and normality versus pleasure and dependency. One of the first DTC pamphlets for Prozac claimed that “Prozac doesn’t artificially alter your mood and it is not addictive. It can only make you feel more like yourself by treating the imbalance that causes depression.” Illicit versus licit; pleasure versus illness-healing; changing-self versus real-self: These are all distinctions that pharmaceutical marketing and its regulatory environment demand. But they also express social ambivalence over wanting drugs, yet fearing they will overstep medical, ethical, or philosophical boundaries to change a patient’s core personality or self.
The social ambivalence toward psychopharmaceuticals in the age of direct-to-consumer advertising takes the form of constant demand for more promises about the relationship between illness and science versus the equally difficult attempt to regulate those promises to conform to science. When Prozac first became commercially available in the late 1980s, it was not supposed to be inherently pleasurable, nor was it supposed to be addictive, and it was used for a widening range of depression and anxiety symptoms. With its growing use and popularization came new questions — no longer about the use of antidepressants to cope with everyday stress and anxiety, but about the use of antidepressants to shape one’s personality and identity. Peter Kramer famously articulated these questions in his 1993 book, Listening to Prozac [25]. In this bestseller, Kramer expressed a new willingness to use Prozac to tinker with his patients’ sense of self. Given the apparent safety of the drug, Kramer didn’t see this as medical bravado so much as a perfectly reasonable experiment made possible by the newest generation of psychopharmacology. He asked rhetorically about a typical encounter with one of his patients, “Who was I to withhold from her the bounties of science?”
In the last 15 years, such romanticized notions of SSRI antidepressants as safe opportunities to tweak a patient’s sense of self with the latest science have received greater public and regulatory scrutiny, from controversies over their questionable efficacy to dramatically reduced uses in children and adolescents to the possible increased risk of suicide from their use. And, as we have seen, the rudimentary science of psychopharmaceuticals has itself been more fundamentally critiqued.
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Science and symptoms
While there is no standard definition of “the placebo effect,” it is broadly used to designate symptom relief (e.g., pain, fatigue, anxiety, depression) that occurs due to such non-pharmacological components of a medical intervention as patient expectation or encouraging a supportive doctor-patient relationship [26]. The placebo effect has been especially troublesome for pharmaceutical companies trying to demonstrate the efficacy of antidepressants in clinical trials [14,15,27]. And yet, while this has led to the accusation that the drug industry promotes psychopharmaceuticals with questionable efficacy, the situation has become more complicated, as some drug marketers are now defending DTC advertising as a way to enhance the placebo effect, leading to better medication compliance: “[A]dvertising strategies [that depict obvious patient relief] not only create consumer demand for the advertised products, but may also create the emotionally conditioned responses and expectancies instrumental to enhancing a placebo effect that occurs when the medication is taken” [28].
Coincidentally or not, with the rise of DTC marketing, some argue that the placebo effect in depression has increased in recent years [29]. But given such efforts on the part of drug marketers to use advertising to bolster the placebo effect, it is striking that the clinical trial — which is what the FDA demands of pharmaceutical companies to connect their drugs to specific illness and prove that their drugs work as advertised — deliberately avoids accounting for marketing itself. Clinical trial participants are typically not told brand names of experimental drugs, and they are not shown advertisements that provide biological explanations of the drugs and depict symptom relief. On the contrary, drug companies worry about the placebo effect as a kind of psychological problematic that must be reduced, not enhanced, and they have gone so far as to screen out so-called “placebo responders” in sham “placebo washout” pre-trials, in which all participants are placed on a placebo antidepressant, and those who experience it as efficacious are discarded from the real clinical trial [30,31]. Here we see a profound disconnect between the protocol of a randomized double-blind control trial that attempts to isolate a drug’s real effect in the clinical trial, in part by removing any advertising messages, versus the attempt to actively generate and leverage the placebo effect through marketing.
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Conclusions
Psychopharmaceutical marketing participates directly in debates over what is scientifically known about mental illness, with important ramifications for doctor-patient interaction, and patient experiences with antidepressants. Right now, antidepressant advertising propagates narrowly biological explanations of depression (especially the seductive notion of simple neurochemical imbalance or deficiency) and leaves out any mention of how often symptom relief may occur because of non-pharmacological interventions. At the same time, it would seem that drug companies are using advertising precisely to inflate such non-pharmacological effects, with the goal of attracting consumers to antidepressants, and then keeping them on them. This disconnect between attempts to eliminate the placebo effect in the clinical trial versus attempts to bolster it through advertising indicates a severe tension in a society that privileges medicalized and scientific narratives about pharmaceuticals on the one hand, but which on the other hand is deeply ambivalent about understanding our relationship to psychotropic drugs. Indeed, if and how antidepressants work is not a straightforward objective question, but rather a larger social contest involving scientific debate, the political history of the pharmaceutical industry, cultural discourses surrounding the role of drugs in society, and the interpretive flexibility of personal experience. Therefore, we need to be open to interpretations of psychopharmaceutical action that acknowledge them as psychologically wily substances whose effects are both socially and pharmacologically determined. Drug advertising most certainly does not take these complexities into account, so it is currently in the hands of consumers and medical and policy decision-makers to do so.
Glossary
DTC direct-to-consumer
SSRI selective serotonin reuptake inhibitor
FDA Food and Drug Administration
FCC Federal Communications Commission
PMDD premenstrual dysphoric disorder

Footnotes
TK partially supported by grant # K24 AT004095 from NCCAM-NIH.
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References
Singer N. Forest, Maker of Celexa, to Pay More Than $313 Million to Settle Marketing Case. New York Times. 2010 Sep 16;:B2.
Carey B. Popular Drugs May Benefit Only Severe Depression, New Study Says. New York Times. 2010 Jan 6;:A12.
Horgan J. Are psychiatric medications making us sicker? The Chronicle of Higher Education. 2011 Sep 18;
Palumbo FB, Mullins CD. The development of direct-to-consumer prescription drug advertising regulation. Food and Drug Law Journal. 2002;57(3):423–443. [PubMed]
Devlin H. Talking therapies are more effective than Prozac-type drugs, says scientist; Serotonin enhancers ‘offer only a placebo effect’ The Times (London) 2010 Jun 14;:13.
Breggin P. Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime. New York: St. Martin’s Griffin; 2009.
MacRae F. Drug firm that covered up Seroxat dangers is let off. Daily Mail (London) 2008 Mar 7;
Lawyers USA Staff. U.S. District Court in Pennsylvania rules wrongful death claim against Paxil maker can proceed. Lawyers Weekly USA. 2008 Sep 22;
Moncrieff J. The Myth of the Chemical Cure: A Critique of Psychiatric Drug Treatment. New York: Palgrave Macmillan; 2009.
Menand L. Head case: Can psychiatry be a science? The New Yorker. 2010;86(2):68.
U.S. Food and Drug Administration. Fluoxetine hydrochloride prescribing information [Internet] [Accessed 2011 18 Oct]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018936s091lbl.pdf .
Moncrieff J, Cohen D. How do psychiatric drugs work? BMJ. 2009;338:b1963. [PMC free article] [PubMed]
Lacasse JR, Leo J. Serotonin and depression: a disconnect between the advertisements and the scientific literature. PLoS Medicine. 2005;2(12):e392. [PMC free article] [PubMed]
Fournier JC, DeRubeis RJ, Hollon SD, Dimidjian S, Amsterdam JD, Shelton RC. et al. Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA. 2010;303(1):47–53. [PubMed]
Turner EH, Matthews AM, Linardatos E, Tell RA, Rosenthal R. Selective publication of antidepressant trials and its influence on apparent efficacy. New Engl J Med. 2008;358(3):252–260. [PubMed]
Kirsch I. Antidepressants and the placebo response. Epidemiol Psychiatr Soc. 2009;18(4):318–322.
Donohue JM, Cevasco M, Rosenthal MB. A decade of rirect-to-consumer advertising of prescription drugs. New Engl J Med. 2007;357(7):673–681. [PubMed]
McDevitt C. The Big Money: Depression and the Recession. The Washington Post. 2009 Aug 30;
Erskine K. The Power of Positive Branding. DTC Perspectives. 2002 Mar-Apr;:16.
McCabe DP, Castel AD. Seeing is believing: the effect of brain images on judgments of scientific reasoning. Cognition. 2008;107(1):343–352. [PubMed]
Ehrlich R. 35 Seconds to DTC Success. DTC Perspectives. 2002
Daly R, Kolassa M. Start Earlier, Sell More, Sell Longer. Pharmaceutical Executive. 2004 Mar 1;
Med Ad News. 2006 May 1;
Healy D. The Creation of Psychopharmacology. Cambridge, MA: Harvard University Press; 2002.
Kramer P. Listening to Prozac. New York: Penguin; 1993.
Miller FG, Colloca L, Kaptchuk TJ. The placebo effect: illness and interpersonal healing. Perspectives in Biology and Medicine. 2009;52(4):518. [PMC free article] [PubMed]
Kirsch I. Antidepressants and the placebo response. Epidemiol Psychiatr Soc. 2009;18(4):318–322.
Almasi EA, Stafford RS, Kravitz RL, Mansfield PR. What Are the Public Health Effects of Direct-to-Consumer Drug Advertising? PLoS Med. 2006;3(3):e145. [PMC free article] [PubMed]
Walsh BT, Seidman SN, Sysko N, Gould M. Placebo Response in Studies of Major Depression: Variable, Substantial and Growing. JAMA. 2002;287:1840–1847. [PubMed]
Fava M, Evins AE, Dorer DJ, Schoenfeld DA. The problem of the placebo response in clinical trials for psychiatric disorders: culprits, possible remedies, and a novel study design approach. Psychoth and Psychosom. 2003;72:115–127.
Faries DE, Heiligenstein JH, Tollefson GD, Potter WZ. The double-blind variable placebo lead-in period: results from two antidepressant clinical trials. J Clin Psychopharmacol. 2001;21:561–568. [PubMed]
Articles from The Yale Journal of Biology and Medicine are provided here courtesy of
Yale Journal of Biology and Medicine

llaurenmarie

Antidepressants don't make you fat. Over eating does.

this.

LuckyAng

No depression? No opinion.

WhitneyAnnabelle

Try taking high doses of lithium (with other mood stabilizers added into the mix eventually) and tell me you won't gain weight. I gained 60 pounds in 5 months, and I wasn't eating more. That being said, once my body was eventually used to a regimen, and I was on a lower dose of lithium with a stimulant-like antidepressant added in, I was able to take the weight off and then some (I lost 85 pounds). I worked my *kitten* off (literally), and I'm also happy to say that I no longer take lithium (though I am still on five different medications). I know there are probably people out there who take psychotropes and experience no side effects, but that wasn't my experience. Don't presume to know the pharmacology of a drug and its effects on a person unless you're trained in that field. Ever.

Edit: And EVEN if you ARE trained in the field, remember that there are, unfortunately, always exceptions to rules.

rudegyal_b

i dont think anti-depressants make you gain weight, they just increase your appetite, which sucks but the rest is up to you

batalina

i was put on Zyprexa when i was 12, and i gained 40 lbs in 3 weeks. not even joking or exaggerating (my stretchmarks are humongous). it wasn't like my mom was feeding me garbage, either. came off the medication, and the weigh gain stopped. my understanding is that that medication is no longer prescribed to adolescents, partly because it is not uncommon for this effect to be experienced this dramatically. In general, Zyprexa has gotten a lot of criticism for this side effect.

Mirdir

Antidepressants are just a bandaid for the problem. All that crap is not good for you. Suck it up.

I sucked it up. I sucked it up for so long I wanted to end my life so I wouldn't have to suck it up anymore. Depression is a treatable illness through therapy and yes even medication. No one has to or should 'Suck it up'. I take anti-depressants and I'm not ashamed of it.

BeautyFromPain

Antidepressants don't make you fat. Over eating does.

this.

That's bull****. A lowered metabolism and hormones entering your body that it isn't used to can make you gain weight so easily without overeating. It's not that easy.

WhitneyAnnabelle

i was put on Zyprexa when i was 12, and i gained 40 lbs in 3 weeks. not even joking or exaggerating (my stretchmarks are humongous). it wasn't like my mom was feeding me garbage, either. came off the medication, and the weigh gain stopped. my understanding is that that medication is no longer prescribed to adolescents, partly because it is not uncommon for this effect to be experienced this dramatically. In general, Zyprexa has gotten a lot of criticism for this side effect.

Zyprexa is NOTORIOUS for weight gain. I've read so many studies about it. I used to take it as needed, and I was always terrified of gaining.