Tallahassee Democrat
Paper cites drug ads for improper diagnosis
By Tony Bridges 

FSU graduate student Jeffrey Lacasse co-wrote a paper that says drug companies mislead the public about the causes and cures of depression. 

Depression - it's a chemical imbalance in the brain, right? Not exactly. But there's a good reason you might think that.

You've seen too many TV commercials, according to Jeffrey Lacasse, a Florida State University graduate student. 

He's co-written a paper - published in this month's issue of the Public Library of Science Medicine - arguing that drug-company advertisements have confused consumers by oversimplifying the causes of and ways to treat depression. 

The paper's gotten plenty of media coverage, from WebMD.com to the Wall Street Journal, and reactions have been strong on both sides. But many in the medical community seem to support Lacasse's position. 

"I really do agree with the spirit of it," said Dr. John Bailey, president of the Florida Psychiatric Society. "I'm concerned about some of the influence the ... marketing has and some of the expectations that it creates." 

There are U.S. Food and Drug Administration rules about what drug makers can and cannot say in advertisements. 

Among other things, they aren't allowed to make claims not supported by established scientific evidence. Or at least, not without admitting that the claims are unsupported. 

What Lacasse and co-author Jonathan Leo say is this: Makers of antidepressants skirt, and sometimes cross, that line by telling consumers that depression is caused by a lack of serotonin and that their pills help boost levels of the brain chemical. 

They offer Zoloft as one example, quoting a TV commercial that claims depression is a medical condition that may be due to a chemical imbalance, and that, "Zoloft works to correct this imbalance." 

The problem is that depression isn't nearly that simple, according to the two. 

And they have a point, said Dr. Wayne Goodman, a University of Florida psychiatrist and chairman of the FDA's psychopharmacologic advisory committee. 

He told the New Scientist magazine that the idea of a chemical imbalance is a "useful metaphor" but not one he uses for his own patients. "I can't get myself to say that," he told the magazine. 

Pfizer, the maker of Zoloft, sees it differently. The company responded to Lacasse's paper with a written statement. 

"There is considerable scientific literature supporting the widespread belief among scientists and physicians that an inadequate level of serotonin in the neuronal synapses of the brain is at least one of the causes of depression," it read, in part. 

But no one's really sure . 

Serotonin was identified as a possible culprit in 1965, but only as a theory with little research to back it up. Medical experts have conducted various studies over the years, but the results have been mixed and the findings questioned over flaws in methodology. 

Other trials have tried, without success, to establish what the "healthy" level of serotonin should be. 

Researchers in one experiment tried to cause depression by artificially depleting serotonin. Another group tried to cure depressed test subjects by triggering huge increases of serotonin. Both failed. 

But what about the pills themselves? Do they work? 

According to the authors, there's evidence those drugs - called selective serotonin reuptake inhibitors - are no more effective than other types of medications. There's also evidence that they make people better . 

"A lot of people feel that the medications are very helpful to them," Lacasse said. "And I would never argue with them on a personal level." What's not clear is whether SSRIs work because the patient has a deficiency, or because the SSRI changes something else within the body. "We haven't actually measured that directly," said Bailey, with the state psychiatric society. 

And it really isn't the point, anyway, Lacasse said. 

Say SSRIs do help with depression. That doesn't prove the problem was caused by a lack of serotonin.

Making that leap would be the same as arguing that because aspirin cures a headache, the headache was caused by an aspirin shortage, Lacasse said. 

OK, so maybe he's right. Maybe depression isn't just a serotonin problem, and the TV commercials are technically incorrect. 

If the pills help, why should consumers care? 

The ads induce tunnel vision, according to Lacasse. 

Bailey said he's seen it in his patients. They come in convinced that all they need to cure their depression is a pill - even when there are other, perhaps more suitable, alternatives, including talk therapy and plain old exercise. 

"That's the problem with trying to educate the public in 30 seconds," Bailey said. "This really should be a process of education and informed consent between a doctor and a patient." 

And that's what he wants, Lacasse said: Patients who learn how to beat depression from their doctors - not a TV commercial pushing a product.