It has been 15 years since the U.S. Food and Drug Administration allowed drug companies to advertise prescription-only medications directly to consumers. Its decision made the United States the only developed country besides New Zealand that permits such advertising.
Many Americans who are thirtyish and older can remember when ads for prescription medicines first began to appear, exhorting us cheerfully to "ask your doctor" about products as deeply personal as antidepressants and erectile dysfunction treatments.
But Madison Avenue has been placing its special touch on prescription drugs for much longer. Pharmaceutical companies have always been allowed to promote their products to doctors by running advertisements in professional journals, and they've done so for decades. Direct-to-consumer ads are a new genre, but they've had a lot to build on.
What follows is a collection of twenty ads for antidepressants and anti-anxiety drugs, spanning the late 1960s to the current year. Many ran in medical journals like JAMA and the American Journal of Psychiatry, encouraging doctors to prescribe brand-name drugs to their patients. Others, aimed directly at the consumer, ran in major publications like Time. Many of them I discovered in the course of researching my book on youth and antidepressants, Coming of Age on Zoloft.
The ads are campy, funny, disturbing, and sometimes downright weird. They show how much has changed in four decades, especially the rise of a marketing pitch that blames depression on a chemical imbalance, not a character flaw. And they document the birth of a rhetoric of personal fulfillment, where using the product is presented as a way of becoming one's real, true self.
But they also show how much has stayed the same. From the beginning of the sample to the end, the ads focus on courtship and family values. The tactics are unchanging: throughout, the advertisers exploit the viewers' insecurities, whether a doctor's fear of letting down a patient, or an individual's fear of failing at life. Every anxiety becomes a mental disorder for which the product is the solution.
Most of all, the ads are full of women, a fact as true today as it was in 1967. Advertising must be at least partly responsible for the fact that over twice as many women as men use antidepressants. The following ads show women who need medication because they fail to thrive in female roles (lover, wife, mother), or because they are oppressed by the demands of those roles (the trapped housewife, the harried working parent). Here they are, a rogue's gallery little changed by 45 years of progress--the singletons, the wallflowers, the ineffective moms.
A Brief History Of Psychotropic Advertising
You can't set her free(01 of20)
Though antidepressants have been available since the 1950s, they didn't become popular until after Prozac's debut in 1987. In the 1960s and '70s, millions who would be treated with an antidepressant today took anti-anxiety drugs, or tranquilizers. Eventually these drugs' association with stay-at-home wives earned them the nickname "mother's little helpers." In this ad for doctors, a young housewife trapped behind a palisade of brooms and mops clutches at her face with a worried expression. The text reads:"You know this woman. Beset by the seemingly insurmountable problems of raising a young family, and confined to the home most of the time, her symptoms reflect a sense of inadequacy and isolation. Serax cannot change her environment, of course. But it can help relieve anxiety, tension, agitation and irritability, thus strengthening her ability to cope with day-to-day problems. Eventually--as she regains confidence and composure--your counsel may be all the support she needs."Source: JAMA, Volume 200, Issue 8 (1967), page 206.
Now she can cope...(02 of20)
In another tranquilizer ad, a woman flashes an easygoing smile while her young daughter, dressed in an Indian headdress, hog-ties her with a long piece of rope. It's a child's game but also a visual play on the plight of a housewife: to be tied down at home.While today's antidepressants are marketed as treatments for innate problems--a chemical imbalance that is likened to a physical disease--tranquilizers were often positioned as treatments for the situational stresses and strains of everyday life. The text calls Butisol a "'daytime sedative' for everyday situational stress," and continues: "When stress is situational--environmental pressure, worry over illness--the treatment often calls for an anxiety-allaying agent which has a prompt and predicable calming action and is remarkably well tolerated."Source: JAMA, Volume 207, Issue 6 (1969), page 1206.
Symbols in a life of psychic tension(03 of20)
The Prozac of its day, Valium has better name recognition than any other tranquilizer. In this Mad Men-era spot, a member of the gray flannel suit set rides a late commuter train home. "B.A. cum laude, V.P. at thirty-two; ECG and complete examination normal (persistent palpitations)." The problem is he's working too hard; Valium is recommended "for reliable relief of psychic tension and associated somatic and depressive symptoms."Eventually, the marketing tactic used here--positioning the product as a cure for situational stress--got tranquilizer makers into trouble. In the early 1970s, the FDA censured manufacturers for portraying tranquilizers as treatments for everyday problems rather than as medications for a specific illness. More than any scientific breakthrough, this legal action may have conditioned modern antidepressant ads' repeated insistence that depression is "a real illness." Source: JAMA, Volume 207, Issue 6 (1969), page 1234.
35, single, and psychoneurotic(04 of20)
Psychopharmaceutical advertisements have often stigmatized single women, but perhaps none so blatantly as this 1970 ad for Valium. On the left: 15 years' worth of snapshots that show the patient with her father and with a series of boyfriends who grow progressively less attractive as she ages. To the right, text:"The purser on her cruise ship took the last snapshot of Jan. You probably see many such Jans in your practice. The unmarrieds with low self-esteem. Jan never found a man to measure up to her father. Now she realizes she's in a losing pattern--and that she may never marry.Valium can be a useful adjunct in the therapy of the tense, over anxious patient who has a neurotic sense of failure, guilt or loss...Valium 10-mg tablets help relieve the emotional 'storms of psychoneurotic tension and the depressive symptoms that can go hand-in-hand with it."Source: Hospital and Community Psychiatry, Vol. 21 No. 5 (May 1970)
A unique structure to support your psychotherapy(05 of20)
A transitional moment. Psychopharmaceutical ads of the 1950s to the '70s often showed psychiatrists giving talk therapy to their patients. Frequently they touted the drug as an agent that would help mainly by making talk therapy more effective. This 1987 ad for the anti-anxiety drug Xanax does the same. But up from below, in a vivid holograph, comes a new theme: the brain. Peppered with a molecular diagram and "scientific"-sounding language about "the incorporation of a triazolo ring into the the basic benzodiazapene structure," the ad appeals to a new breed of psychiatrists who aspired to think of themselves not as mere counselors but 'real' medical doctors.Source: American Journal of Psychiatry, August 1987, page A35.
I got my Mommy back(06 of20)
While tranquilizer ads of the 1960s often featured a lonely housewife, antidepressant ads of the '90s zeroed in on the professional working mother drying to balance career with child-rearing.0 In this physician-directed ad for Effexor, a mother in business attire kneels beside a brown bag bulging with healthy groceries, to embrace a little boy. Beneath a chart of dosing options is the crayoned slogan, "I got my Mommy back."Source: American Journal of Psychiatry, May 1998, Pages A23-A25
I got my playfulness back (07 of20)
In the 1980s and '90s, psychiatry aspired to leave its Freudian past behind--but traditional psychiatry's notorious obsession with mothering is alive and well in the many antidepressant ads that show mothers as patients and play up, in fine psychoanalytic fashion, the damage that a mother's depression can do to her children. This physician-directed ad for Effexor invites doctors to consider the harm that withholding treatment might do--not just to the patient, but to her young son as well.Source: American Journal of Psychiatry, January 2001, pages A32-A33
Power that speaks softly(08 of20)
A mother in a business suit smiles as she's led down a sidewalk by a boy and girl in soccer uniforms. The slogan, "Power that speaks softly," references both the potency of the drug, and the quiet authority that a mother might wish to wield over her children. Obliquely, it refers to another female conundrum of the day: how to remain feminine while also trying to break through the corporate world's glass ceiling.Source: American Journal of Psychiatry, April 1999, Page A1
Depression hurts. Prozac can help(09 of20)
The first direct-to-consumer ad campaign for an antidepressant, the "Depression hurts" series ran in prominent general interest magazines. The ads used nonthreatening cartoon-style imagery, and extensive text that introduced Americans not just to a new treatment, Prozac, but to the disease of depression itself. The ad reads:"Depression isn't just feeing down. It's a real illness with real causes. Depression can be triggered by stressful life events, like divorce or a death in the family. Or it can appear suddenly, for no apparent reason."Some people think you can just will yourself out of a depression. That's not true. When you're clinically depressed, one thing that can happen is that the level of serotonin (a chemical in your body) may drop. So you may have trouble sleeping. Feel unusually sad or irritable. Find it hard to concentrate. Lose your appetite. Lack energy. Or have trouble feeling pleasure. Thse are some of the symptoms that can point to depression--especially if they last for more than a couple of weeks and if normal, everyday life feels like too much to handle."To help bring serotonin levels closer to normal, the medicine doctors now prescribe most often. Prozac isn't a 'happy pill.' It's not a tranquilizer. It won't take away your personality. Depression can do that, but Prozac can't."Source: Time; July 21, 1997; page 19
Sue's playing with her kids again... just like normal(10 of20)
In his 1993 bestseller Listening to Prozac, the psychiatrist Peter Kramer portrayed the then-new drug as both appealing and uncanny. Prozac, he wrote, had changed his patients' very personalities in surprising ways, making the shy outgoing and the meek brave. He worried aloud that the drug could obliterate the self as we knew it, ushering in an age of "cosmetic psychopharmacology" in which every aspect of our personhood might be sculpted by drugs.Eli Lilly's early ads for Prozac seem designed to counter any such Brave New World associations with its product. This physician-directed series riffs on the phrase "just like normal." With cartoonish imagery of fun activities gone just a little bit askew (a missed basketball shot, a kite stuck in a tree), and insistent text ("Depression can keep your patients from enjoying the simple pleasures of life. The things they enjoy doing--their way. Like going up for a jump shot and catching 'nothing but rim.' They count on you to help them feel like normal again. You can count on Prozac to help restore normal functioning"), the ads hammer their point home: far from being a futuristic emotional steroid, Prozac merely restores people to their lovably imperfect selves.Source: American Journal of Psychiatry, April 1999, Page A7
Thank You(11 of20)
A special message from Eli Lilly and Company to America's doctors. From the January, 2000 issue of the American Journal of Psychiatry:"Thank you. On behalf of your patients, thank you for helping to make Prozac one of Fortune magazine's "Products of the Century. And that's on top of recognition given to the inventors of Prozac for their contributions to society from both the U.S. Department of Commerce and the National Inventors Hall of Fame. We couldn't have done it without you."Source: American Journal of Psychiatry, January 2000, Page A7
Millions suffer from chronic anxiety. Millions could be helped by Paxil(12 of20)
A month after 9/11, a direct-to-consumer print ad for Paxil taps into the national mood. A tense-looking woman walks down a city street, surrounded by blurry figures and the words "Irritability," "Sleep problems," "Fatigue," "Anxiety," "Restlessness," "Muscle tension," "Worry." Despite the inevitable associations of the image, the ad doesn't talk about situational stress but about biological imbalance: small print claims that "10 million people" in America suffer from Generalized Anxiety Disorder and that Paxil "works to treat the chemical imbalance" believed to cause it.Source: Time; October 15, 2001, Page 55.
What's Standing Between You and Your Life?(13 of20)
Selling personal authenticity. Direct-to-consumer ads like this one often portray depression as an illness that obscures the true self, and pitch the product as capable of restoring the 'real' you. The text reads:"Life is too precious to let another day go by feeling not quite 'yourself.' If you've experienced some of these symptoms of depression nearly every day, for at least two weeks, a chemical imbalance could be to blame. And life can feel difficult ALL DAY. That's why you need relief ALL DAY."Again, the patient is a female whose symptoms are preventing her from connecting (here, visually on the page) with the men in her life. Like many DTC ads, this one works partly by fomenting doubt: everyone experiences some of the named symptoms sometimes; the ad demands that the viewer asks herself whether those feelings amount to an illness that's "standing between you and your life."Source: Time; October 21, 2002; Page 67
Overpowered by ANXIETY, Empowered by Paxil(14 of20)
Borrowing a word from the women's movement, a physician-directed Paxil ad shows a professional woman who is "Overpowered by ANXIETY" but "Empowered by Paxil."Fine copy reads: "Generalized anxiety disorder patients may suffer for up to 10 years before diagnosis and treatment, often believing that anxiousness is a part of their personality."Source: American Journal of Psychiatry, January 2002, Page A1
See depression. See the data. See a difference(15 of20)
35, single, and psychoneurotic--redux. In this physician directed ad from 2004, treatment means the difference between staring out a window alone, and commanding the attention of a handful of hunks.Source: American Journal of Psychiatry, July 2004, pages A41-A43
Something extra(16 of20)
In another physician-directed ad, Effexor means one-third more canoodling. Beneath text advising that "1/3 more patients got their life back," a woman flaunts an accessory of significance in psychopharmaceutical ads past and present: a wedding ring.Source: American Journal of Psychiatry, January 2002, page A13.
Is she just shy? Or is it Social Anxiety Disorder?(17 of20)
In the early 2000s, SSRI antidepressants including Paxil and Zoloft were approved for the treatment of Social Anxiety Disorder. Critics have argued that the popularization of Social Anxiety Disorder is a case of medicalization, claiming that S.A.D. is indistinguishable from the ordinary human trait of shyness. Here, a physician-directed Zoloft ad from 2004 takes advantage of the ambiguity.Source: American Journal of Psychiatry, August 2004, page A1
Do you often get nervous around people?(18 of20)
A DTC ad for Zoloft sells Social Anxiety Disorder to the public. Text invites readers to map moments of insecurity onto the definition of an illness: "Do you often get nervous around people? Do you blush, sweat, or tremble? Or think that others are judging you? Do these feelings interfere with your daily life? These could be signs of social anxiety disorder. While the cause is unknown, ZOLOFT can help."Source: InStyle, November 2004, Page 373
Depression can make you feel like you have to wind yourself up to get through the day(19 of20)
Familiar symptoms. A DTC ad for the antidepressant Pristiq presents an image that most people can relate to: a slumpy doll suggests the feeling of having to "wind yourself up to get through the day."Small print reads: "Depression is a serious medical condition that can take so much out of you. You may experience frequent sadness, a loss of interest, lack of energy, and trouble concentrating. PRISTIQ is thought to work by affecting the levels of two chemicals in the brain, serotonin and norepinehrine. PRISTIQ may be a key in helping to treat your depression. So ask your doctor about PRISTIQ."Source: Newsweek; June 15, 2009; Page 3
"After 6 weeks on an antidepressant, I was still struggling with my depression."(20 of20)
The future. Not an antidepressant but an "atypical antipsychotic," Abilify came to market in 2002 as a treatment for schizophrenia. 'Atypicals' are powerful drugs with serious side effects that can include marked weight gain, body tics that may be permanent, and a heightened risk of type II diabetes, but they have found widening use in recent years, largely due to intensive marketing following FDA approval of the drugs as an add-on to traditional antidepressant therapy. In 2009, atypicals became the highest-selling class of drugs in the country by revenue, partly because a month's supply can cost from $400 to $1200. As older antidepressants go off patent, atypicals become more and more important to drug makers' bottom lines.Abilify's "still struggling" DTC campaign reaches out to consumers who already take an antidepressant--currently about 11% of the adult population of the U.S.--but haven't found the relief they were looking for. In the ad, a woman stands on a sunny streetscape, holding an umbrella with dark, tired eyes, which drizzles rain and shadow on her. Text reads: "If you've been on an antidepressant for at least 6 weeks and are still struggling with depression, having ABILIFY (aripiprazole) added to your antidepressant may help with unresolved symptoms as early as 1-2 weeks. ABILIFY is a prescription medicine used to treat depression when an antidepressant alone is not enough...Ask your doctor about the option of adding ABILIFY."Source: Time; March 26, 2012; Page 19
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