In a recent print ad for the prescription drug Abilify, a woman claws her way out of a deep hole in the ground. In another, a woman stands on a sunny city street, beneath an umbrella that drips rain just on her. In a TV commercial from the same series, a woman is followed around town by a furry blue bathrobe that represents her illness.
There is nothing unusual about the gender makeup of the campaign for Abilify, a medication used to treat persistent depression. In fact, it is typical of an industry sector that has long singled out women in its marketing.
Maybe you've noticed the tendency: almost inevitably, advertisements for antidepressants and anti-anxiety medications portray women as the users of these drugs. That was true the month after 9/11, when an advertisement for Paxil that ran in national magazines like Time showed a tense woman clutching her purse strap on a busy street. It was true a couple years ago, when a chirpy woman in a TV commercial for Pristiq explained that without the medication, she had to "wind herself up to get through the day."
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Formal investigation confirms the perception. In a multi-year survey, one researcher found that 93% of print advertisements for antidepressants featured a woman—specifically a white, adult woman—as their central figure. In TV commercials with multiple sufferers, women inevitably receive greater emphasis. Some drug makers court women's business by concentrating their advertising budgets on women's and entertainment magazines.
Advertisements like these help to shape patterns of psychiatric drug consumption in the U.S., where women use a large majority of antidepressants prescribed. According to the U.S. C.D.C., 16% of American women use an antidepressant each month, compared to 6% of men. A study last year by Medco Health Solutions, a major pharmacy-benefit manager, found that one in four women in this country has a prescription for a psychiatric drug.
The practice of targeting women as potential consumers of psychopharmaceuticals dates back decades. In the 1950s and 1960s, as today, advertisements overwhelmingly depicted the users of antidepressants and anti-anxiety drugs as female. Aimed at doctors rather than the public, those advertisements presented their viewers with an array of troublesome feminine stereotypes, from frigid wives, to harried mothers, to domineering matrons. Physicians of the day wrote innumerable prescriptions for tranquilizers, which earned the nickname "mother's little helpers" for their use among women.
Those advertisements worked to connect a sense of widespread unease among postwar middle-class women with the idea of mental illness. A 1967 advertisement for the tranquilizer Serax shows a tense young housewife trapped behind a palisade of mops and brooms. "You can't set her free," the headline reads. "But you can help her feel less anxious."
Others stigmatized women's ennui, their bossiness, and even their marital status. A 1970 ad for Valium featuring a woman named "Jan" bears the tagline "35, single, and psychoneurotic." Talk about not mincing words.
We'd like to think we've come a long way since then. Decades of social change have exploded women's options, making the trapped-housewife scenario a thing of the past. Psychiatry has changed too, shedding the vestiges of psychoanalysis, with its sexist gender assumptions (penis envy, anyone?), for an emphasis on psychopharmaceuticals and the hard science of the brain.
But today's pharmaceutical advertisements continue the practices of the 1950s. They home in on women, leveraging the gender anxieties of our own day to enlarge demand for their products. The ads' stock characters are lonely single urbanites and stressed-out working moms. And their signature hook is an appeal to modern a woman's sense of guilt and exhaustion as she struggles to balance—with zest—the modern demands of a career with the traditional desire to be fully available to all who depend on her for emotional support. It's no coincidence that when men appear in these advertisements, they are often the husbands, boyfriends and sons whom a woman's depression lets down.
Bias in psychiatric drug marketing harms both genders. It makes women vulnerable to over-diagnosis and unnecessary or even dangerous treatment, saddling them with the expense of prescriptions and doctors' visits, the risk of side effects, records of pre-existing conditions, and the stigma that can come from a mental health diagnosis. Men suffer too. When we think of depression as a female concern, we are less likely to recognize its signs in men, who then go without a chance at appropriate treatment.
It's time for drug companies to stop perpetuating the abuses of the past by continuing to make women their mark. Gendered antidepressant advertising drags the condescending sexism of the Mad Men era into the present day, in the guise of modern medicine.
Those who defend the overrepresentation of women in antidepressant advertising will argue that it is appropriate because depression is a disease that disproportionately affects women. As support, they will cite the existence of the gender gap itself, mentioning the often-repeated fact that women are diagnosed with depression about twice as frequently as men are.
But their arguments will be plagued by a circular logic. Until we stop presenting the face of depression, to doctors and the public alike, as an inevitably female face, we will have no means of knowing whether gendered advertisements reflect an epidemic of women's depression, or are a prime cause of it.
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