Can antidepressants end the recession?

During a downturn, it's fun to point out the "bright spots"—those sectors or products that are actually doing well when all the rest are struggling. For example, there were plenty of reports over the past year of retail items—like lipstick, chocolate, and macaroni and cheese—that bucked downward trends and sold well during the slump. Supermarkets saw a rise in customer traffic, too, as families opted to cook at home more and eat out less. A particularly uplifting story in February told of a turnaround in business for shoe cobblers, as more people were fixing old shoes instead of buying new ones. While these stories are cautiously upbeat, news of an uptick in antidepressant sales despite—or perhaps thanks to—the recession was just plain depressing.

Helplessness, pessimism, and persistent sadness—the main symptoms of depression—didn't seem to abate at all as the economy crumbled. About 164 million antidepressant prescriptions were written in 2008, 4 million more than in 2007, according to IMS Health, a health care information and consulting company. Antidepressants were the third most prescribed drug in 2008, hitting $9.6 billion in sales, up from $9.4 billion the year before. Last month, Eli Lilly & Co. (LLY) reported that second-quarter sales for Cymbalta—which is on the verge of surpassing Effexor as the nation's best-selling antidepressant—had risen 14 percent over last year. Our national reliance on these drugs is a stubborn trend. A study published in the August issue of the Archives of General Psychiatry found that from 1996 to 2005, antidepressant use in the United States had doubled.

While it's worrying that more and more Americans are considered miserable enough to warrant prescription drugs, there may be some solace in the fact that antidepressants are in some ways good for the economy. Depression may cost the United States as much as $83 billion a year, according to a cost-of-illness analysis published in the Journal of Clinical Psychology in 2003. The study found that while costs associated with treatment of depression accounted for $26 billion of the burden, twice that amount—$52 billion—was attributed to missed workdays and lost productivity. "The workplace is the venue where the most significant costs are incurred," says Paul Greenberg, a health economist who led the research.

Calculating lost productivity is never a precise science, but it's not hard to see why the depressed would be less effective at work. Not only do depressed workers tend take more days off, the study revealed, but the symptoms of the illness can make it very hard to get work done while on the job, too. "If you had to write out a list of symptoms that would be highly correlated with bad performance at work, symptoms of depression are almost exactly consistent with where those productivity declines would be expected," Greenberg explained, citing depressed patients' difficulties concentrating, remembering details, and making decisions. Antidepressants are designed to—and by many accounts do—curb some or all of these symptoms.

Pharmaceutical companies will be quick to point out the positive effects of these drugs for anyone—and everyone—whose doctor thinks he or she may need them. In Eli Lilly's "Depression Hurts" campaign for Cymbalta, a female voice asks, "Where does depression hurt?" The answer: "Everywhere." And then, "Who does depression hurt?" You guessed it: "Everyone." Sadly, there is a market for these commercials. While an estimated 15 million Americans suffer from major depression, most don't get treatment. And, as it turns out, the business of turning frowns upside down is particularly lucrative. Whereas other costly conditions—such as heart conditions or cancer tend to strike late in life—most people get depressed when they're much younger, usually between the ages of 15 and 30. Besides setting in early, depression can be frequent. Up to 75 percent of people who have one episode of depression will experience another, and with each recurring episode, the risk of another one increases even more.

Drug companies realize the importance of resonating with customers early and often, in hopes of establishing customer loyalty for those who do need to take the pills long-term—so much so that they've been willing to give away the pills for free. In May, Pfizer (PFE) announced that it would offer many of its brand-name drugs—including the popular antidepressant Zoloft—for free to people who had lost their jobs and health insurance coverage. "Our aim is to help people bridge this point," Dr. Jorge Puente, Pfizer's head of pharmaceuticals outside the United States and Europe, said in an interview. Another aim was probably less charitable: to keep those patients from switching from Pfizer brands to cheaper generics.