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Advertising's chemical imbalance

Zoloft commercial stolen from Ad-Rag.com

I couldn't help but notice Lilly's new "depression hurts" ad in a recent New York Times Magazine. A little infograph off to the side says, "Serotonin and norepinephrine may play a role in depression."

Aha! I thought, upon noticing the “may.” Could the FDA finally be going after pharmaceutical companies for falsely advertising that a lack of serotonin causes depression?

For years, as a recent essay in PLoS Medicine explains, advertising has pitched the causes of depression as a lack of certain brain chemicals--particularly serotonin--though evidence is sorely lacking.  In fact, the PLoS writer provides a handy collection of quotes illustrating the divide between what the drug ads say verses the scientists. For example:

ADVERTS SAY: "Celexa helps to restore the brain's chemical balance by increasing the supply of a chemical messenger in the brain called serotonin." ...to bring serotonin levels closer to normal, the medicine doctors now prescribe most often is Prozac."

SCIENTISTS SAY: "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." -- John Horgan, in The Undiscovered Mind (1999). "Some have argued that depression may be due to a deficiency of norepinephrine or serotonin because the enhancement of noradrenegic or serotonergic neurotransmission improves the symptoms of depression. However, this is akin to saying that because a rash on one's arm improves with the use of a steroid cream, the rash must be due to a steroid deficiency." -- Stephen M. Stahl, Essential Psychopharmacology (2000).

Hell, even Prozac king Peter Kramer says Prozac--the first major selective serotonin reuptake inhibitors (SSRI)--is no more effective than earlier drugs, which had little effect on serotonin. And in fact, other treatments--both drug an nondrug--have been found to be just as effective as SSRIs.

In short, there exists no rigorous corroboration of the serotonin theory, and a significant body of contradictory evidence. Far from being a radical line of thought, doubts about the serotonin hypothesis are well acknowledged... To our knowledge, there is not a single peer-reviewed article that can be accurately cited to directly support claims of serotonin deficiency in any mental disorder, while there are many articles that present counterevidence.

But, alas, my theory about Lilly righting its wrongs was, uh, wrong. In a commercial for the same campaign, a motherly voiceover states matter-of-factly that depression "is thought to be caused by an imbalance between serotonin and norepinephrine."

Thought to be caused...? By whom?  Let me guess...

Lilly.

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For more info on the false claims made about the causes of depression, see Eliott Valenstein Blaming the Brain.

Thanks to Yoni for the PLoS tip.