The Big Money: Depression and the Recession
During a downturn, we tend to seek the "bright spots" -- sectors or products that are doing well when all the rest are struggling. For example, there were plenty of reports over the past year about retail items -- lipstick, chocolate, and macaroni and cheese -- that were bucking downward trends and selling well during the slump. While these stories were cautiously upbeat, news of an uptick in antidepressant sales despite -- or perhaps because of -- the recession was just plain depressing.
Helplessness, pessimism and persistent sadness -- the main symptoms of depression -- didn't seem to abate as the economy crumbled. About 164 million antidepressant prescriptions were written in 2008, 4 million more than in 2007, according to IMS Health, a health-care information and consulting company.
Antidepressants were the third most prescribed type of drug in 2008, hitting $9.6 billion in sales, up from $9.4 billion the year before. Last month, Eli Lilly reported that second-quarter sales for Cymbalta -- which is on the verge of surpassing Effexor as the nation's best-selling antidepressant -- increased 14 percent over the past year. Our national reliance on these drugs is a stubborn trend. A study published in the August issue of Archives of General Psychiatry found that from 1996 to 2005, antidepressant use in the United States doubled.
Depression may cost the United States as much as $83 billion a year, according to an analysis published in the Journal of Clinical Psychology in 2003. The study found that although costs associated with treatment of depression accounted for $26 billion of the burden, twice that amount -- $52 billion -- was attributed to missed workdays and lost productivity. Not only do depressed workers tend to take more days off, the study revealed, but the symptoms of the illness can also make it difficult to get work done while on the job.
"If you had to write out a list of symptoms that would be highly correlated with bad performance at work, symptoms of depression are almost exactly consistent with where those productivity declines would be expected," said Paul Greenberg, a health economist who led the research and says patients with depression have difficulties concentrating, remembering details and making decisions. Antidepressants are designed to -- and by many accounts do -- curb some or all of these symptoms.
Pharmaceutical companies will be quick to point out the positive effects of these drugs for those whose doctors think they may need them. As it turns out, the business of depression is particularly lucrative. Whereas other costly conditions, such as heart conditions or cancer, tend to strike late in life, most people experience depression when they're much younger, usually between the ages of 15 and 30. Besides setting in early, depressive episodes tend to recur.
Drug companies realize the importance of resonating with customers early and often, in hopes of establishing loyalty from those who need to take the pills over a long period -- so much so that they've been willing to give the pills away. In May, Pfizer announced that it would offer many of its brand-name drugs -- including the popular antidepressant Zoloft -- free to people who had lost their jobs and health insurance. While the campaign was marketed as sympathetic, another aim was probably less charitable: to keep those patients from switching from Pfizer brands to cheaper generics.
Rising reliance on antidepressants doesn't benefit Big Pharma exclusively, though. Drug companies are notorious for big marketing campaigns -- bolstering revenue streams for businesses that rely on those ads.
"Certainly they're contributing big time to advertising revenue," says Charles Barber, author of "Comfortably Numb: How Psychiatry Is Medicating a Nation."
In the first quarter of 2009, as automotive ads -- long the top advertising category in the Unites States -- plummeted by 28 percent, according to Nielsen rankings, pharmaceutical companies' ad spending was more consistent. It still dropped, but only by 11 percent. Drugmakers were the third-biggest spender of ad money in that period. Without those purchases, some media outlets already floundering in the thinned-out ad market would have been much worse off. Because most depression sufferers are women, female-targeted lifestyle magazines get a particular boost from companies pushing antidepressants.
The most important benefit that antidepressants can provide, of course, is to those taking the medications. While the salutary effects are just the relief that some people need, a few skeptics have theorized that the pills may change a person's mind-set too much.
Nearly a decade ago, Randolph Nesse, a professor of psychiatry at the University of Michigan, suggested that investors numbed by antidepressants would take risky bets and make bad decisions.
They may "become far less cautious than they were before, worrying too little about real dangers," he wrote. He predicted that, as more people turned to prescription medications, the collective effect would cause a Wall Street bubble to grow and burst.
Did Prozac cause the most recent market free fall?
Seems like a stretch, but if so, then maybe the "great recession" should have been called a depression all along.