If you have doubts that Americans have lost faith in a Higher Power, take a look at how we worship the biomedical model of depression. The biomedical model is so entrenched in our culture that it has become gospel—preached in doctor’s offices, reinforced by advertising, and accepted as unquestioned truth, even though it’s been debunked. Depression was sold to us as a simple problem of serotonin insufficiency, a convenient narrative that made drug companies like Eli Lilly, Forest Pharmaceuticals, and Pfizer very rich.
As a former pharmaceutical advertising writer, I not only witnessed the explosive growth in antidepressant drugs, I contributed to it. The reframing of depression as a problem of impaired brain chemistry has been a goldmine for the pharmaceutical industry, with today’s global marketplace for antidepressants worth over $20 billion. Unfortunately, the messaging of Big Pharma is hard to reverse once embedded into our collective brains.
My Journey: From Pharmacy School to Pharma Marketing
I entered medical advertising in 1980, fresh out of pharmacy school and eager to break into medical communications. Landing my first job as a junior copywriter at a global pharmaceutical ad agency in New York City felt like a dream come true. Writing about breakthrough drugs and explaining the science behind them was both challenging and meaningful.
At the time, there was no direct-to-consumer advertising, with drug companies only advertising medications to physicians. Equally important, my client’s drugs were generally superior to existing treatments, with each claim supported by two clinical trials demonstrating clinically relevant improvements in survival, outcomes, or quality of life. In those days, FDA approval actually meant something.
But in less than a decade, I watched the industry morph from what I thought was an ethical and innovative business into a soulless money machine. What began as a wonderful career combining my scientific knowledge with creative writing gradually revealed itself as something far more troubling: I was helping to manufacture “facts” about diseases and treatments that would shape medical practice for decades.
The Industry Transformation: The “Me Too” Movement in Pharma
The 1980s ushered in an era of greed and profit-mongering in the pharmaceutical industry. It even has a name—the “me too” movement—not the one about sexual harassment, but the one where building billion-dollar brands replaced actual innovation.
Big Pharma—already profitable and growing greedier—realized that real innovation was expensive, risky, and time-consuming. This wasn’t just a shift in marketing; it was a complete transformation of the industry’s business model. Companies realized they could take an existing drug, tweak a molecule, file for a new patent, and market it as an “innovative” breakthrough. Soon, companies would switch from marketing breakthroughs to marketing virtually identical drugs, and no class of medications exemplified this better than SSRIs (selective serotonin reuptake inhibitors).
This business transformation necessitated a corresponding major transformation in pharmaceutical advertising and marketing. Companies that normally would be rivals became “allies” in efforts to market their very similar antidepressants. Their combined marketing power led to an unprecedented, carefully orchestrated promotional effort that fundamentally changed people’s understanding of mental health.
The chemical imbalance theory—specifically the idea that depression is caused by insufficient serotonin in the brain—was in truth a marketing necessity. Prozac, the first SSRI, was marketed as the panacea to this chemical imbalance, fundamentally reshaping how depression was perceived and treated. For SSRIs to make sense as a treatment, depression had to be reframed as a simple chemical deficiency. This marketing effort provided a compelling narrative positioning medication as a life-long solution for those with depression, even though the initial SSRI studies were only six weeks long.
By 2018, Americans were spending $17.4 billion annually on antidepressants, highlighting how deeply this narrative had permeated the thinking of the medical and the lay community.
Case Study: The Serotonin Theory and SSRI Marketing
Before the 1980s, depression wasn’t widely seen as a problem of brain chemistry. It was understood as an emotional disorder or melancholic condition influenced by personal life circumstances and social factors. For pharmaceutical companies to successfully commercialize SSRIs, they had to convince psychiatrists (and then patients) that depression was due to a chemical imbalance of serotonin—all fixable with a magic pill.
The chemical imbalance theory was powerful in its simplicity: too little serotonin in the brain causes depression, and SSRIs work by increasing serotonin levels. This narrative accomplished several critical marketing objectives at once. It medicalized depression, making it a biological disease rather than an emotional or social condition. It provided a simple explanation that doctors could easily discuss in a brief office visit. And it created a logical path to medication as the first-line treatment. What wasn’t widely discussed was how little scientific evidence supported this theory. Instead, most of the research supporting it came from the labs of corporations.
Fluoxetine, better known as Prozac, was introduced in 1988 as the first SSRI. Eli Lilly, the company behind Prozac, funded studies and published journal articles relentlessly reinforcing the message that depression was caused by 5-hydroxytryptamine (5-HT), the chemical name for serotonin.
Ray Fuller, co-discoverer of fluoxetine and a biochemist at Lilly, Charles Beasley, a Lilly medical officer, and David Wong, a Lilly neuroscientist, published numerous papers reinforcing the link between serotonin and depression. A 1991 journal article titled “Role of Serotonin in Therapy of Depression and Related Disorders” by Ray Fuller appearing in the prestigious Journal of Clinical Psychiatry (JCP) provided evidence supporting the serotonin theory.
But, there was something most doctors didn’t realize. This particular issue of JCP was a journal supplement—paid for by Eli Lilly. Unlike peer-reviewed research, these supplements bypass rigorous scientific scrutiny—but medical ad writers cited them as authoritative sources for years. Journal supplements, which appear to be regular journals, are actually a form of paid marketing, serving as a vehicle to promote corporate research science.
Even more damning are statements revealed when reading the entire article, which begins by saying that SSRIs are an effective treatment for depression and then goes on to question the strength of the serotonin-depression link. A more complete reading reveals that the relationship between 5-HT antagonism and antidepressant effects was understood even then to be more hypothetical than definitive, and activation of serotonin receptors was not necessarily the mechanism that alleviates depression.
Yet, we did not mention these particular conclusions in our marketing materials. Advertising at its very core involves presenting a highly selective set of facts, carefully cherry-picked by drug companies to leave a favorable impression.
The Mechanisms of Influence: How Marketing Shapes Medical Practice
As the industry changed, I too had to adapt. My colleagues and I became the architects of new forms of advertising, ones that expanded the definition of depression, presented the serotonin theory, and even educated physicians and patients about the diagnostic criteria of depression itself, so as to create ever-larger markets for psychiatric drugs. The goal? To expand the number of treatable patients, so each company got a hefty slice of the billion-dollar antidepressant pie.
I spent years creating educational content for doctors, including repurposing antidepressant research into advertorials—ads designed to look like independent editorial content. This form of marketing is especially powerful because it creates the illusion of scientifically validated information.
I’ll never forget attending an American Psychiatric Association conference in the 1990s, where doctors stopped by my client’s booth quoting verbatim from advertorials I had written—believing them to be independent research. That moment crystallized for me just how deeply marketing, when disguised as education, shaped prescribing practices in the United States.
Our tactics included:
- Ads to physicians that blurred the line between education and sales pitches
- Detailing materials alerting doctors that depression was a biochemical imbalance
- Targeting consumers with diagnostic checklists encouraging anyone feeling unhappy to self-diagnose with depression and talk to their doctor
- Direct-to-consumer (DTC) advertising that normalized medication as the first-line treatment
The pharmaceutical industry’s influence over modern medical practice is profound, as are their marketing budgets which allow them to dominate the flow of medical information. Most people trust their physicians to make independent, evidence-based decisions. But here’s the reality: your doctor isn’t spending their spare time combing through medical journals and textbooks at night and independently verifying research. They’re too exhausted from seeing patients, documenting notes in electronic health records, and dealing with the frustrations of our mechanized healthcare system.
Except for a small number of academic clinical experts, most physicians get their information from:
- Medical conferences (often sponsored by drug companies)
- News media (reporting research pitched by PR firms representing drug companies)
- Sales reps (trained with marketing materials written by people like me)
- Industry-backed journal supplements (articles created by experts with PhDs working for medical communication companies)
- Thought leaders (“Key Opinion Leaders”)—doctors paid to present at peer-to-peer meetings
The Legacy and Way Forward
Antidepressants are now as American as apple pie—with a whopping 24% of women in the U.S. reporting receiving treatment for depression in 2023.The increase in antidepressant usage has been especially sharp among young people: since the pandemic, antidepressant use more than doubled among girls aged 12-17 and rose over 50% among women aged 18-25. This explosive growth in SSRI usage also helped pave the way for exponential growth in use of all psychotropic drugs as well—stimulants for ADHD and antipsychotics used to augment antidepressants, manage bipolar disorder, and address behavioral issues in children, adolescents, and nursing home residents.
What was sold as a quest for better treatments was in reality a corporate feeding frenzy. The idea that depression is caused by a serotonin deficiency didn’t take hold because of independent, groundbreaking research—it was aggressively manufactured by the pharmaceutical industry. The strategy was so effective that, even today, many people—including physicians—cling to this belief, despite little evidence and questionable science. However, in reality:
- Drug companies funded the research on the chemical imbalance theory of depression
- Drug companies controlled the messaging around SSRIs
- Drug companies profited when we bought into their version of mental illness
Large marketing budgets allow the pharmaceutical industry to amplify its messages, while critical voices struggle to be heard. Modern psychiatric care isn’t built on science—it’s built on sales. This is why we hear more about antidepressants than about proven and effective lifestyle treatments for depression like exercise and cognitive behavioral therapy.
Follow the money, and you will find that many medical theories—such as the serotonin theory of depression—are rooted in an unholy alliance between industry, scientific publishers, and medical researchers.
What can readers do with this information? First, approach claims about “chemical imbalances” with healthy skepticism. Second, when discussing treatment options with healthcare providers, ask about evidence for both medication and non-medication approaches. Third, recognize that pharmaceutical marketing is designed to create demand—not necessarily to provide balanced information.
The biomedical model of depression isn’t gospel—it’s a compelling story that was crafted to sell pills. As a society, we need to reclaim the narrative around mental health from corporate interests and return to a more holistic understanding of mental health that acknowledges the importance of psychological, social and spiritual factors to emotional well-being.
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