Is Advertising Affecting Prescribing Rates of Psychiatric Medications?

A recent study found that consumer advertising of psychiatric drugs has increased prescribing, but may have a mixed effect on the quality of treatments.

“On a basic level, the goal of our review was to begin addressing an important and rarely examined public health question," said lead author Sara Becker, PhD. “Is this enormous multibillion dollar industry of direct-to-consumer advertising of psychiatric medication affecting public health in a positive or negative way? There are many possible ways to answer this question -- we began by taking a close look at patient and physician behavior in response to these ads.”

In most of the world, prescription drug advertisement is not legal. However, television, radio, internet, and print ads for prescription drugs in the United States are quite common. Recently, drugs for mood disorders and other conditions have become the most widely advertised and prescribed.

Despite conversations about benefits or dangers of direct-to-consumer advertising, few studies have explored that relationship between advertising and physicians. Included in the current analysis, published by the Journal of Clinical Psychiatry, were only 4 studies that included advertised psychiatric medications, tracked prescriptions based on patient requests, and document-specific doctor-patient interaction at point of care.

In 1 study, actors posing as patients discussed varying degrees of depression with the physicians. The patients would then ask for a specific drug they saw in an advertisement, ask for a general antidepressant, or not ask for a drug.

The prescribing rates were higher when patients asked for a drug compared with when they did not. Other studies compared prescribing rates in Canada where advertising is forbidden to prescribing rates in the United States.

The 3 studies that involved observations of real patients showed that requests for specific drugs are typically not a large part of discussions, according to the current study. These requests occurred in less than 10% of the cases.

However, the 1 study discovered that patients in the United States request medications at twice the rate of patients in Canada. While advertising is presumably an influencer of drug requests and prescribing rates, the researchers investigated whether these drugs were the optimal treatment option.

The findings suggest that patients with severe symptoms who requested medication are more likely to receive it. This may be a beneficial for some patients, but could be harmful for some.

Researchers also found that patients with less severe or transient depression were also more likely to receive prescriptions, even though they may not be medically necessary. The limited data shows that direct-to-customer advertising may have both positive and negative effects on prescribing rates for patients who need, and who do not need the treatments.

The researchers said that more studies need to be conducted to explore this relationship more in depth.

“In 2007, the editor of Annals of Family Medicine referred to direct-to-consumer advertising of prescription drugs as 'a huge, uncontrolled public health experiment on American people,'” Dr Becker concluded. "Our review supported this statement. Very few rigorous studies have been conducted on DTCA over the past 20 years. But our review also didn't support a clear decision for or against DTCA -- the limited data aren't all bad or all good. It's possible that DTCA might help some people and might lead to over-prescribing in others. The most important conclusion of our study is that more research is needed.”