Direct-to-consumer advertising (DTCA): the case of the serotonin hypothesis and SSRIs ads

I would like to recommend Pharmamotion readers one of the most popular articles in PLoS Medicine:

Serotonin and Depression: A Disconnect between the Advertisements and the Scientific Literature. Jeffrey R. Lacasse, Jonathan Leo

The article is a definitely a must read for those interested in direct-to-consumer advertising (DTCA) issues. However,for those who don’t have enough time, I reproduce from the article the tables that expose the contrast between what experts say about SSRis and what industry wants the public to think. Visit the article to see the complete tables

Selected Quotations Regarding Serotonin and Antidepressants

Quotation Source

“Although it is often stated with great conﬁdence that depressed people have a
serotonin or norepinephrine deﬁciency, the evidence actually contradicts these
claims” [50]. Professor Emeritus of Neuroscience Elliot Valenstein, in Blaming the Brain (1998), which
reviews the evidence for the serotonin hypothesis

“Given the ubiquity of a neurotransmitter such as serotonin and the multiplicity
of its functions, it is almost as meaningless to implicate it in depression as it is to
implicate blood” [11]. Science writer John Horgan, in his critical examination of modern neuroscience, The
Undiscovered Mind (1999).

“A serotonin deﬁciency for depression has not been found” [51]. Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, in Prozac Backlash (2000)

“So far, there is no clear and convincing evidence that monoamine deﬁciency accounts for depression; that is, there is no “real” monoamine deﬁcit” [44]. Psychiatrist Stephen M. Stahl, in a textbook used to teach medical students about psychiatric medications, Essential Psychopharmacology (2000)

“I spent the ﬁrst several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deﬁ ciency of brain serotonin. In fact, we cannot measure brain serotonin levels in living human beings so there is no way to test this theory. Some neuroscientists would question whether the theory is even viable, since the brain does not function in this way, as a hydraulic system” [54] Stanford psychiatrist David Burns, winner of the A.E. Bennett Award given by the Society for Biological Psychiatry for his research on serotonin metabolism, when asked about the scientiﬁc status of the serotonin theory in 2003.

Table 2. Selected Consumer Advertisements from SSRIs from Print, Television, and the World Wide Web

Medication Selected Content from Consumer Advertisement

Citalopram “Celexa helps to restore the brain’s chemical balance by increasing the supply of a chemical messenger in the brain called serotonin. Although the brain chemistry of depression is not fully understood, there does exist a growing body of evidence to support the view that people with depression have an imbalance of the brain’s neurotransmitters” [57].

Paroxetine “Chronic anxiety can be overwhelming. But it can also be overcome…Paxil, the most prescribed medication of its kind for generalized anxiety,
works to correct the chemical imbalance believed to cause the disorder” [60]

“While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription
Zoloft works to correct this imbalance. You just shouldn’t have to feel this way anymore” [5].

This is the sertraline tv ad the article mentions:

And a great parody by Mad TV:

Quotation	Source
“Although it is often stated with great conﬁdence that depressed people have a serotonin or norepinephrine deﬁciency, the evidence actually contradicts these claims” [50].	Professor Emeritus of Neuroscience Elliot Valenstein, in Blaming the Brain (1998), which reviews the evidence for the serotonin hypothesis
“Given the ubiquity of a neurotransmitter such as serotonin and the multiplicity of its functions, it is almost as meaningless to implicate it in depression as it is to implicate blood” [11].	Science writer John Horgan, in his critical examination of modern neuroscience, The Undiscovered Mind (1999).
“A serotonin deﬁciency for depression has not been found” [51].	Psychiatrist Joseph Glenmullen, clinical instructor of psychiatry at Harvard Medical School, in Prozac Backlash (2000)
“So far, there is no clear and convincing evidence that monoamine deﬁciency accounts for depression; that is, there is no “real” monoamine deﬁcit” [44].	Psychiatrist Stephen M. Stahl, in a textbook used to teach medical students about psychiatric medications, Essential Psychopharmacology (2000)
“I spent the ﬁrst several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression, results from a deﬁ ciency of brain serotonin. In fact, we cannot measure brain serotonin levels in living human beings so there is no way to test this theory. Some neuroscientists would question whether the theory is even viable, since the brain does not function in this way, as a hydraulic system” [54]	Stanford psychiatrist David Burns, winner of the A.E. Bennett Award given by the Society for Biological Psychiatry for his research on serotonin metabolism, when asked about the scientiﬁc status of the serotonin theory in 2003.

Medication	Selected Content from Consumer Advertisement
Citalopram	“Celexa helps to restore the brain’s chemical balance by increasing the supply of a chemical messenger in the brain called serotonin. Although the brain chemistry of depression is not fully understood, there does exist a growing body of evidence to support the view that people with depression have an imbalance of the brain’s neurotransmitters” [57].
Paroxetine	“Chronic anxiety can be overwhelming. But it can also be overcome…Paxil, the most prescribed medication of its kind for generalized anxiety, works to correct the chemical imbalance believed to cause the disorder” [60]
	“While the cause is unknown, depression may be related to an imbalance of natural chemicals between nerve cells in the brain. Prescription Zoloft works to correct this imbalance. You just shouldn’t have to feel this way anymore” [5].