Effect
of direct-to-consumer advertising on patients'
request for antidepressants
Major
depression remains stigmatized, under-recognised
and under-treated. Antidepressants are most
cited prescription drugs in direct-to-consumer
(DTC) advertising. Opponents of DTC fear that
this can lead to overprescribing, while its
supporters feel that it can help to promote
efficacious treatments and encourage patients to
seek care. A study was conducted to investigate
the effects on physician prescribing, of
DTC-stimulated requests for antidepressants by
depressed patients.
The trial, which was randomized and controlled
using actors playing the role of standardized
patients (SP), recruited primary care physicians
(internists and family physicians). Six SP roles
were created by crossing two conditions
(symptoms consistent with major depression or
adjustment disorder) with three request types
(brand-specific, general, or none). The SPs were
randomly assigned to make 298 unannounced visits
such that each physician saw one SP with major
depression and one with adjustment disorder. The
SPs made a brand-specific drug request, a
general drug request, or no request (control
condition) in approximately one third of visits.
Analysis of written prescriptions and drug
samples, mental health referral, SP written
reports on primary care follow-up, visit
audiorecordings, and chart review were
collected, and the effects of request type on
prescribing were evaluated.
The SP roles were convincing and the rate that
physicians suspected an SP was only 13%. In
major depression, antidepressant prescribing
rates were 53%, 76%, and 31% for SPs making
brand-specific, general, and no requests,
respectively. In adjustment disorder, these
rates were 55%, 39%, and 10%, respectively. SPs
who portrayed major depression and requested
either brand-specific or general drug were more
likely to receive minimally acceptable initial
depression care than patients making no
request.
These results show that antidepressants were
prescribed more often when SPs requested them
and that patient requests have considerable
influence on physicians. DTC advertising
increases consumer awareness of conditions and
treatments which can motivate patients to seek
medical care and request drug therapy, which can
lead to increased prescribing. Kravitz
RL, Epstein RM, Feldman MD, Franz CE, Azari R,
Wilkes MS, Hinton L, Franks P. Influence of
patients' requests for direct-to-consumer
advertised antidepressants - A randomized
controlled trial. JAMA 2005,
293:1995-2002.