05/19/2015 09:02 am ET | Updated Jun 02, 2015

How Vintage Advertisements Got Depression Totally Wrong


(Photo credit: Serax) Published in the Journal of the American Medical Association, 1967

While vintage advertising usually conjures images of "Mad Men"-era consumer campaigns -- think the iconic "I'd like to buy the world a Coke" commercial from the show's final episode -- print ads for pharmaceutical drugs often skipped the consumer altogether. Drug advertisements peppered the pages of medical journals like the American Journal of Psychiatry and the Journal of the American Medical Association, creating a direct pitch line between the ad men selling Effexor and Valium and the doctors who prescribed anti-depressants to patients.

Eleven percent of Americans over the age of 12 take antidepressants, with 2.5 times as many women taking medication for depression as men, according to the Centers for Disease Control and Prevention. But these rates don't accurately represent the state of mental illness in America, according to Jonathan Metzl, professor of sociology and psychiatry and director of the Center for Medicine, Health and Society at Vanderbilt University, who thinks there might be more to these statistics than meets the eye.

"For a long time, depression was presented in ways that were very problematic in American society," Metzl said. "One of the things I found in my research, was that drug ads, and particularly drug ads to doctors, showed almost entirely white women. There was a cultural message that white women were the only people who could afford to be depressed and there was a strong correlation between being married and being mentally healthy," he said.

One in 10 Americans suffers from depression, and for many, anti-depressants are a necessary, and sometimes even lifesaving, treatment. Still, the fact remains that anti-depressants are overprescribed to a remarkable degree. In 2013, a large-scale study published in Psychotherapy and Psychosomatics found that two-thirds of patients given a diagnosis for a major depressive episode in the previous year did not meet the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the condition.

The Media Portrays Depressed Men And Women Differently

These ads make ordinary life stages (singledom, motherhood, menopause) seem like conditions that need to be treated.

One study that Metzl worked on, published in Social Science and Medicine in 2004, examined the way men and women with depressive illness were portrayed in newspapers and magazines between 1985 and 2000. The study found that articles described women who needed SSRI drugs (or selective serotonin re-uptake inhibitors, a type of anti-depressant) in non-medical, emotional terms, like being "overwhelmed by sadness" or "feeling down," for example. Men, on the other hand, were more likely to be described using clinical terms from the DSM. They suffered from an illness with "biochemical roots" or had "obsessive compulsive disorder," ads said. In addition, the reasons women were taking SSRI drugs were overwhelmingly tied to marriage, mothering, menstruation and menopause, while reasons given for men to take the drugs were tied to aggression and athletics. In cases where race was identified or assumed, 95 percent of the representations were white people.

Being over-marketed to, or completely ignored by marketers, can have real-life implications. "Cultural representations are incredibly powerful, because they reinforce cultural stereotypes and sometimes they create them," Metzl told The Huffington Post. "For a long time, overrepresentation of white, middle-class women in American media and movies and drug ads led to an overprescription of anti-depressants and anti-anxiety drugs for women and an under-diagnosis for all other kinds of people -- people of color, people who were gay or lesbian, everybody else, basically."

Indeed. Compared to the 16.6 percent of white adults, only 7.6 percent of black adults used mental health services, according to a 2011 SAMHSA survey.


(Photo credit: Valium) Published in Hospital and Community Psychiatry, 1970

The advertisements throughout this story, which appeared in medical journals between 1967 and 2004, play on a variety of cultural stereotypes surrounding womanhood and depression. One advertisement, which appeared in the medical journal Hospital and Community Psychiatry in 1970, pathologizes single women, prompting doctors to prescribe Valium to women like "Jan," a 35-year-old who "never found a man to measure up to her father."

A Woman's Mental Health Is Tied To Her Marriage Status

Early on, stereotypically unhappy, single women made the rounds in advertising. "Pharmaceutical ads in medical journals for about 40 or 50 years, very often showed depressed, untreated women without wedding rings," Metz said. "What they would do then, is show mentally health women who had wedding rings and who were happily married."

Other ads medicalized motherhood. One ad for the anti-depressant Effexor, published in the American Journal of Psychiatry in 2001, depicts a woman in black and white, sitting hunched over with her hand on her head, beneath the words "depression or generalized anxiety disorder." Presumably after taking Effexor, the same woman glows as she holds her toddler in the air in the ad's feature image. The tagline reads, "I've got my playfulness back."


(Photo credit: Effexor) Published in the American Journal of Psychiatry, 2001

These good mother/bad mother and depressed single lady ads flatten depression, making ordinary life stages such as singledom, motherhood, and menopause seem like conditions that need to be treated. The lack of images depicting people of color and men, who also suffer from depression, is troubling, since depression can be an isolating even when a person is in the target treatment demographic.

Somewhat ironically, the Food and Drug Administration's relaxation of broadcast advertising regulations in 1997 has brought more diversity along with it. Today, television ads include more people of color and men, as well as gender-neutral cartoons, but some of the old stereotypes persist.

Here are a few more recent ads that span a 6-year period, published in the American Journal of Psychiatry, that demonstrate the clear ways in which pharmaceutical companies got it wrong (and in some cases, they still do). The poor treatment of women in these ads didn't end as women's rights moved into the mainstream. If anything, such advertisements simply shapeshifted, folding anxieties like career achievement and balancing work life and family life into the litany of treatable conditions that affect modern-day women.

Published in 1998:

(Photo credit: Effexor)

Published in 2002:

(Photo credit: Effexor)

Published in 2004:

(Photo credit: Effexor)

  • Summer Weather
    Seasonal Affective Disorder (SAD) is most commonly associated with winter blues, and it afflicts about 5 percent of Americans. But for less than 1 percent of those people, this form of depression strikes in the summer. Warm weather depression arises when the body experiences a "delay adjusting to new seasons," says Alfred Lewy, MD, professor of psychiatry at Oregon Health and Science University, in Portland. Instead of waking and enjoying dawn, the body has a hard time adjusting, he says, which could be due to imbalances in brain chemistry and the hormone melatonin. More from Tips for Dating With DepressionThe Most Depressing States in the U.S.Depressing Jobs: Career Fields With Hight Rates of Depression
  • Smoking
    Smoking has long been linked with depression, though it's a chicken-or-egg scenario: People who are depression-prone may be more likely to take up the habit. However, nicotine is known to affect neurotransmitter activity in the brain, resulting in higher levels of dopamine and serotonin (which is also the mechanism of action for antidepressant drugs). This may explain the addictive nature of the drug, and the mood swings that come with withdrawal, as well as why depression is associated with smoking cessation. Avoiding cigarettes -- and staying smoke free -- could help balance your brain chemicals.
  • Thyroid Disease
    When the thyroid, a butterfly-shaped gland in the neck, doesn't produce enough thyroid hormone, it's known as hypothyroidism, and depression is one of its symptoms. This hormone is multifunctional, but one of its main tasks is to act as a neurotransmitter and regulate serotonin levels. If you experience new depression symptoms -- particularly along with cold sensitivity, constipation and fatigue -- a thyroid test couldn't hurt. Hypothyroidism is treatable with medication.
  • Poor Sleep Habits
    It's no surprise that sleep deprivation can lead to irritability, but it could also increase the risk of depression. A 2007 study found that when healthy participants were deprived of sleep, they had greater brain activity after viewing upsetting images than their well-rested counterparts, which is similar to the reaction that depressed patients have, noted one of the study authors. "If you don't sleep, you don't have time to replenish [brain cells], the brain stops functioning well, and one of the many factors that could lead to is depression," says Matthew Edlund, M.D., director of the Center for Circadian Medicine, in Sarasota, Fla., and author of "The Power of Rest."
  • Facebook Overload
    Spending too much time in chat rooms and on social-networking sites? A number of studies now suggest that this can be associated with depression, particularly in teens and preteens. Internet addicts may struggle with real-life human interaction and a lack of companionship, and they may have an unrealistic view of the world. Some experts even call it "Facebook depression." In a 2010 study, researchers found that about 1.2 percent of people ages 16 to 51 spent an inordinate amount of time online, and that they had a higher rate of moderate to severe depression. However, the researchers noted that it is not clear if Internet overuse leads to depression or if depressed people are more likely to use the Internet.
  • End Of A TV Show Or Movie
    When something important comes to an end, like a TV show, movie, or a big home renovation, it can trigger depression in some people. In 2009, some "Avatar" fans reported feeling depressed and even suicidal because the movie's fictional world wasn't real. There was a similar reaction to the final installments of the Harry Potter movies. "People experience distress when they're watching primarily for companionship," said Emily Moyer-Gusé, Ph.D., assistant professor of communication at Ohio State University, in Columbus. With "Avatar," Moyer-Gusé suspects people were "swept up in a narrative forgetting about real life and [their] own problems."
  • Where You Live
    You can endlessly debate whether city or country life is better. But research has found that people living in urban settings do have a 39 percent higher risk of mood disorders than those in rural regions. A 2011 study in the journal Nature offers an explanation for this trend: City dwellers have more activity in the part of the brain that regulates stress. And higher levels of stress could lead to psychotic disorders. Depression rates also vary by country and state. Some states have higher rates of depression and affluent nations having higher rates than low-income nations. Even altitude may play a role, with suicide risk going up with altitude.
  • Too Many Choices
    The sheer number of options available -- whether it's face cream, breakfast cereal or appliances -- can be overwhelming. That's not a problem for shoppers who pick the first thing that meets their needs, according to some psychologists. However, some people respond to choice overload by maximizing, or exhaustively reviewing their options in the search for the very best item. Research suggests that this coping style is linked to perfectionism and depression.
  • Lack Of Fish In The Diet
    Low intake of omega-3 fatty acids, found in salmon and vegetable oils, may be associated with a greater risk of depression. A 2004 Finnish study found an association between eating less fish and depression in women, but not in men. These fatty acids regulate neurotransmitters like serotonin, which could explain the link. Fish oil supplements may work too; at least one study found they helped depression in people with bipolar disorder.
  • Poor Sibling Relationships
    Although unhappy relationships with anyone can cause depression, a 2007 study in the American Journal of Psychiatry found that men who didn't get along with their siblings before age 20 were more likely to be depressed later in life than those who did. Although it's not clear what's so significant about sibling relationships (the same wasn't true for relationships with parents), researchers suggest that they could help children develop the ability to relate with peers and socialize. Regardless of the reason, too much squabbling is associated with a greater risk of developing depression before age 50.
  • Birth Control Pills
    Like any medication, the pill can have side effects. Oral contraceptives contain a synthetic version of progesterone, which studies suggest can lead to depression in some women. "The reason is still unknown," says Hilda Hutcherson, M.D., clinical professor of obstetrics and gynecology at Columbia University, in New York. "It doesn't happen to everyone, but if women have a history of depression or are prone to depression, they have an increased chance of experiencing depression symptoms while taking birth control pills," Dr. Hutcherson says. "Some women just can't take the pill; that's when we start looking into alternative contraception, like a diaphragm, which doesn't contain hormones."
  • Rx Medications
    Depression is a side effect of many medications. For example, Accutane and its generic version (isotretinoin) are prescribed to clear up severe acne, but depression and suicidal thoughts are a potential risk for some people. Depression is a possible side effect for anxiety and insomnia drugs, including Valium and Xanax; Lopressor, prescribed to treat high blood pressure; cholesterol-lowering drugs including Lipitor; and Premarin for menopausal symptoms. Read the potential side effects when you take a new medication, and always check with your doctor to see if you might be at risk. More from Tips for Dating With DepressionThe Most Depressing States in the U.S.Depressing Jobs: Career Fields With Hight Rates of Depression