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Recent research claims that the major part of the observed reduction in suicide rates during the 1990s can be explained by the increase in the prescription of antidepressants. However, this conclusion is based on research that only looks at raw correlations; confounding effects from other variables are not controlled for. Using a rich Swedish data set, we reinvestigate the issue. After controlling for other covariates, observed as well as unobserved, that might affect the suicide rate, we find, overall, no statistically significant effects from antidepressants on the suicide rate; when we do get significant effects, they are positive for young persons. Regarding the latter result, more research is needed before any firm policy conclusion can be made.

During the past two decades, there has been a growing awareness of the impact of mental illness on the population (Regier et al., 1988; U.S. Department of Health and Human Services, 1999; World Health Organization, 2001). However, only recently have issues surrounding its effect on the labor force been raised (Berndt et al., 2000; Dewa & Lin, 2000; Kessler et al., 1999; Marcotte et al., 1999; Stewart et al., 2003).

Depressive disorders are a focus of growing social and economic concern. While antidepressant medications are widely accepted, they are ineffective for nearly 40% of users, and cause numerous adverse drug reactions. The pharmacogenomics of depression attempts to better understand the role of genetic variation in antidepressant metabolism in the hope of improving drug efficacy and tolerability. However, the development and delivery of genome‐based antidepressants face many hurdles. In this paper we provide an overview of the potential impact of the pharmacogenomics of depression on public mental health care by focusing on the social and ethical issues at stake. These include questions about genetic testing, informed consent, drug access, and market fragmentation. We end the paper with a brief discussion of the wider context and how the pharmacogenomics of depression relates to broader trends in psychiatry and biomedicine.

Depression and insomnia are very significant pathologies in cancer patients as they contribute to the patient's overall cure and quality of life. Moreover, untreated depression and ongoing insomnia are associated with decreased immune responses and lower survival rates. With all disease states and especially with cancer, close attention to drug-drug interactions and the potential impact on the efficacy of therapy is paramount. One area of particular interest due to the lack of well-done clinical trials is drug-drug interaction(s) between antidepressants and cancer treatment. Pharmacokinetics of a certain drug allows for prediction of certain drug interactions based on chemical properties of the agents involved. If the agents depend on their metabolites for activity, active drug level will be decreased through this enzyme inhibition. In this paper, we looked at the cytochrome-P450 drug interactions between antidepressants and sleep aids with Selective Estrogen Receptor Modulators (SERM). Newer SERM metabolisms are less influenced by interactions with medications used to treat depression. However, tamoxifen metabolism could be severely altered by several antidepressants. This has direct consequences as patients on tamoxifen and antidepressant can have double the risk of relapse to cancer in two years. We discussed those interactions and made recommendations for clinical use.

The purpose of this paper is to determine the extent to which exposure to a television commercial for an antidepressant drug (Cymbalta^®) compared to another commercial (Weight Watchers^®) influenced participants' knowledge of the drug (including side effects and indications) and self‐reported likelihood of seeking an antidepressant medication.

A randomized‐group design with two conditions was used with a sample of an ethnically diverse group of college students (n=498). Scores assessing drug knowledge and self‐reported likelihood of drug seeking and scores from the Beck Depression Inventory‐II (BDI‐II) were analyzed.

The Cymbalta^® group had higher drug‐knowledge scores than did the control group. Differences in drug‐seeking scores across conditions were not significant; however, drug‐knowledge scores and drug‐seeking scores were negatively related. Across groups, BDI‐II scores were positively related to drug seeking.

These results suggest that direct‐to‐consumer (DTC) advertising may educate consumers regarding medications, at least in the short term. Self‐reported intention to seek an antidepressant medication was significantly higher in participants who met the BDI‐II threshold for major depressive disorder, regardless of experimental condition.

A decreased desire to seek antidepressants, possibly due to increased familiarity with drug side‐effects, suggests that advertising may be educating viewers about important concerns about medication and that may impact their desire to seek those drugs.

Direct‐to‐consumer advertising (DTCA) of pharmaceuticals remains controversial, yet few experimental studies have examined the effects of DTCA on drug knowledge and drug‐seeking behavior of potential consumers.

This chapter explores how direct-to-consumer advertisements (DTCA) for major depression and anxiety disorders use contemporary gender scripts to sell medications and disease definitions to consumers, and in the process reflect and reinforce those scripts for both men and women. Between 1997 and 2006, antidepressant DTCA in popular magazines overwhelmingly depicted depression as a (white) female disorder, as did anti-anxiety DTCA, although not to such an extreme extent. In addition, DTCA often alerted men to the benefits they might reap if the women in their lives sought treatment, while suggesting that women had a responsibility to seek such treatment for the sake of their loved ones. Moreover, DTCA disproportionately encouraged women to monitor their emotions while encouraging men to monitor their physical sensations. Finally, DTCA suggested that medication would yield benefits for women primarily in their close relationships and for men primarily in their work lives, thus reinforcing the binary sex divisions implicit in hegemonic masculinity and emphasized femininity. At a broader level, DTCA studied for this article suggest to both women and men that individuals should monitor themselves and others for a wide variety of common emotions, behaviors, and physical sensations, thus individualizing social problems and encouraging the expansion of medical authority over everyday life.

To examine aging Puerto Ricans’ experiences with and perceptions of depression treatment.

In-depth analysis of eight exemplary cases from ethnographic interviews with a subsample of 16 aging Puerto Ricans in the Boston area who are part of the Boston Puerto Rican Health Study.

The results show that respondents were resistant to accepting pharmacological treatment for their depression, and they often characterized antidepressants as “dope.” Moreover, they claimed that in addition to their health problems, social stressors such as financial strain, lack of jobs, housing problems, and social isolation are triggering or contributing to their depression. Because of this, they express reluctance in accepting clinical treatment only, and suggest that broader social issues and other health needs ought to be addressed as part of an effective treatment. For many, pharmacological treatment is acceptable only in the more severe forms of depression.

These results have important implications for improving the quality of depression treatment and reducing health disparities for mainland Puerto Ricans.

Even though recent studies continue to show a high frequency of depression among Puerto Ricans, issues of treatment quality are still understudied and ethnographic accounts are especially lacking. Our study offers an exploratory investigation of this unresolved research issue.

It has been suggested that the medical profession contributes to the stigmatisation of those who experience mental health problems, through ‘iatrogenic’ stigma. This study explores how pharmaceutical companies and their advertising agencies think psychiatrists view people who suffer from mental health problems, as expressed through the design and content of advertisements for neuroleptic medication intended for the psychiatric profession. All pharmaceutical company advertisements appearing in the British Journal of Psychiatry in 1999 were analysed: quantitatively as to drug type, advertisement format and demographic characteristics of subjects portrayed in advertisements, and qualitatively as to content, accompanying text and the theme of the advertisement. Although adverts for neuroleptic drugs constitute a minority of all adverts appearing in the journal in 1999, they are larger than antidepressant adverts, use more pages, and are more likely to portray people suffering from schizophrenia as inactive, socially isolated, and leading empty, meaningless lives. Some of the images resonate with the popular mythology of schizophrenia as ‘other’ and ‘split personality’. From this we conclude that pharmaceutical company advertisements for neuroleptic drugs do indeed present stigmatising images of people suffering from schizophrenia. Editors of medical journals should scrutinise advertisements for potentially stigmatising content. It is time for a debate about the position of glossy advertisements in the pages of medical journals.Declaration of interest: Philip Thomas is co‐chair of the Critical Psychiatry Network and has written extensive critiques of the biomedical model.