AdWatch: Abilify finds lucrative new audience

Consumer Reports News: July 30, 2009 04:21 PM

American doctors wrote more than 164 million prescriptions for antidepressants in 2008, making it the third most-prescribed of any class of drugs. Now Bristol-Myers Squibb (BMS) is tapping into that vast market with an aggressive advertising campaign for Abilify (aripiprazole), its blockbuster antipsychotic medication. Originally approved for treating schizophrenia and soon after that, bipolar disorder, Abilify hit the real jackpot in late 2007 when it won approval as an add-on treatment for people with major depression who haven’t gotten adequate relief from taking an antidepressant alone. It’s the first antipsychotic medicine approved by the U.S. Food and Drug Administration for that use.

BMS is promoting the depression indication in print ads and in the ubiquitous TV commercial critiqued in the video at right. We chose Abilify for this seventh edition of our AdWatch series because, frankly, the ad scares us.

It’s not the commercial itself that we find frightening; watch it and you’d swear that it’s just another antidepressant ad. But Abilify isn’t just another antidepressant. It’s a member of a class of drugs known as atypical (or "newer") antipsychotics, which have different—and in some cases, more serious—side effects than the SSRI antidepressants (which have plenty of safety concerns of their own). Abilify’s popularity hinges partly on the fact that it may be less likely to cause certain side effects, such as weight gain and elevated blood-sugar levels, than other drugs in its class, such as olanzapine (Zyprexa). But it still carries some risk of those, as well as of restlessness, decreased white blood-cell count, and a condition called tardive dyskinesia, or involuntary repetitive movements of the limbs and body that can become permanent. In two studies sponsored by the manufacturer, 25 percent of patients who added Abilify to their antidepressant drug experienced akathisia (inner restlessness and urge to move around), compared to 4 percent of patients taking an antidepressant plus a placebo. And, Abilify costs around 45 times as much per month as many antidepressants.

We totally get why Bristol-Myers Squibb is doing this. There are, after all, only so many people in the world who have schizophrenia or bipolar disorder. Depression, on the other hand, is a veritable cash cow among mental-health conditions. One in seven people will experience a depressive episode at some point in their lives. If you want to sell upwards of $2 billion a year of a drug, that’s the kind of market you need. And, in Abilify’s defense, the use of antipsychotics along with antidepressants in hard-to-treat cases of depression isn’t new. Psychiatrists have long prescribed the drugs off-label for that purpose, and there’s one drug on the market, Symbyax, that combines olanzapine with the antidepressant fluoxetine (Prozac and generic). But because of their harsher side effects, antipsychotics are usually considered an option of last resort for depression, to be tried only after exhausting other options such as a different antidepressant, a different dose of the same antidepressant, or a combination of two antidepressants together. Not surprisingly, the Abilify ad doesn’t get into that. Quite the contrary, it seems to suggest that if the first antidepressant you try isn’t enough, you can, and should, jump right onto Abilify as an add-on.

If this business of marketing an extremely powerful psychiatric drug to the public on TV and in popular magazines like People seems insidious to you, well, us too. But there could be more to come. Perhaps inspired by Abilify’s unbelievable success, the competing (and seriously side-effect plagued) drug quetiapine (Seroquel) is now seeking approval as a depression add-on. What a very depressing battle of the ads that could be.

Jamie Kopf Hirsh, associate editor

Watch our AdWatch critique of the Abilify ad. Read our free Best Buy Drug reports on antidepressants and antipsychotics, and find out which treatments work best for depression (subscribers only).

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