Researchers funded by the National Institute of Mental Health (NIMH), have found that requests from patients for medications have a "profound effect" on physicians prescribing for major depression and adjustment disorder. These findings indicate that direct-to-consumer (DTC) marketing of prescription medications for depression may exert significant influence on treatment decisions.
Researchers from the University of California at Davis, the University of Rochester, and the University of California at San Francisco conducted the study, which appears in the April 27, 2005, issue of the Journal of the American Medical Association.
"The use of direct marketing for treatment of depression may boost familiarity with potential treatments of the disorder," said Thomas R. Insel, M.D., director of the National Institute of Mental Health. "However, we must ensure that treatment is based on evidence-based science rather than evidence-based marketing."
Critics of direct-to-consumer marketing fear the advertisements lead to over-prescribing. Proponents believe they can serve a useful educational function. This study addresses this issue of over- or under-prescribing. The researchers randomly assigned actors portraying patients with symptoms of major depression or adjustment disorder to make 298 unannounced visits to 152 family physicians and general internists recruited from solo and group practices and health maintenance organizations in California and New York.
Actor-patients were randomly assigned a disorder and a type of medication request based on the assumption that the direct-market approach could encourage patients to seek effective care. They made brand-specific requests for Paxil®, saying they learned about the medication from a commercial; or general requests for medication, not a specific brand, saying they viewed a television program about depression which 'got them thinking'. Actor-patients assigned "none" made no request concerning medications.
Two visits were spread over several months so as to avoid detection by the participating doctors; 13 percent of the time, the doctors suspected the actor-patient was from the study. Researchers collected results through a review of actor-patient written reports, audiotapes from the visits, medical charts, and written prescriptions or drug samples.
People with major depression manifest several symptoms that, in combination, interfere with the ability to work, study, sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime. Adjustment disorder is an abnormal and excessive reaction to a life stressor, such as starting school, getting divorced, or grief (for example, car accidents, natural disasters, medical conditions). In addition to mental health symptoms, actor-patients in the study complained of either wrist or back pain.