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Influence of Direct-to-Consumer Advertising on Antidepressant Prescriptions

Patient requests for a specific antidepressant resulted in more prescriptions for that drug, even when the indication was weak.

What are the actual effects of direct-to-consumer (DTC) advertising? In this innovative randomized controlled trial, standardized patients — trained actors following scripted roles — made 298 unannounced and surreptitiously audiotaped visits to 152 primary care physicians during several months (physicians agreed to the blinded visits).

Standardized patients portrayed people with either adjustment disorders or major depressive disorder (MDD). They were trained to ask for a specific antidepressant (paroxetine, which currently was being advertised on television), any antidepressant, or no antidepressant; each physician was scheduled randomly to see six standardized patients, each of whom made one of these requests for each portrayal. Blinded reviewers assessed medication prescribing and adequacy of care.

Standardized patients portraying MDD and making brand-specific, general, or no requests for medication were prescribed any antidepressant in 53%, 76%, and 31% of cases, respectively. For standardized patients portraying adjustment disorder, the corresponding prescription rates were 55%, 39%, and 10%. Paroxetine was prescribed in 27%, 2%, and 4% of MDD portrayals and in 37%, 10%, and 0% of adjustment-disorder portrayals. Overall, of 100 standardized patients making brand-specific requests for paroxetine, 32 received it; of 99 standardized patients making general requests, only 6 received paroxetine. Minimally acceptable care (i.e., antidepressant prescription, mental health referral, or follow-up visit within 2 weeks) for standardized patients portraying MDD and making medication requests as above was provided in 90%, 98%, and 56% of cases.

Comment: The results of this clever study suggest that direct-to-consumer advertising can substantially increase brand-specific prescriptions, often for weak indications (e.g., adjustment disorder). However, it also appears that DTC advertising can stimulate patients to make requests that improve their overall adequacy of care.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine May 13, 2005

Citation(s):

Kravitz RL et al. Influence of patients' requests for direct-to-consumer advertised antidepressants: A randomized controlled trial. JAMA 2005 Apr 27; 293:1995-2002.

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