A pill for every ill

When the first antidepressant came to market in the 1950s, the company that marketed it did not think there were enough depressed people for the drugs to make a profit. By 2000, though, antidepressants were a $7 billion business in the U.S. alone. Outpatient treatment for depression increased threefold between 1987 and 1998.

Many people blame the pharmaceutical industry for huge increases in the number of depression diagnoses, especially in countries like the U.S. where drug companies can advertise their products directly to consumers on television, radio and in magazines. One recent study by Richard Kravitz at the University of California-Davis, aimed to test this idea.

Kravitz sent actors into doctors' offices. Half presented symptoms of depression, half did not. Each actor either asked for the antidepressant Paxil specifically, asked for help from a drug without specifying which one they wanted, or made no request. Those who asked for a drug were more likely to get one than those who did not request medication, whether or not they had symptoms of depression.

Gordon Parker of the Black Dog Institute in Sydney, Australia, also points out that the drug industry has benefited from the somewhat broad definition of depression. "Having a lack of precision has made it absolutely appropriate for the pharmaceutical industry to say, 'We're just treating this broad, generic condition,'" he says.

Others are not so convinced that patients are being led towards a decision. "One view is that this is being marketed by the doctors and the pharmaceutical industry. I think that misses the argument that people themselves are much more interested in having a better life," says Ian Hickie of the Brain and Mind Research Institute at the University of Sydney. "People are always looking to enhance themselves. I don't think clinical depression is a lifestyle issue. It's just like surgery being a serious thing, but that doesn't stop the cosmetic surgery industry."