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Essay

The Latest Mania: Selling Bipolar Disorder
David Healy

ne of the most famous directto-consumer television adverts for a drug begins with a vibrant woman dancing late into the night. A background voice says, “Your doctor probably never sees you when you feel like this.” The advert cuts to a shrunken and glum figure, and the voiceover now says, “This is who your doctor usually sees.”Cutting again to the woman, in active shopping mode, clutching bags with the latest brand names, we hear: “That’s why so many people with bipolar disorder are being treated for depression and not getting any better—because depression is only half the story.” We see the woman again depressed, looking at bills that have arrived in the post before switching to seeing her again energetically paintingher apartment. “That fast- talking, energetic, quick tempered, overdoing it, up-all-night you,” says the voiceover, “probably never shows up at the doctor’s office, right?” No drugs are mentioned. But viewers are encouraged to log onto www.bipolarawareness.com, which takes them to a Web site called “Bipolar Help Center,” sponsored by Lilly Pharmaceuticals, the makers of olanzapine (Zyprexa). The Website contains a “mood disorder questionnaire” (http:⁄⁄www. bipolarhelpcenter.com/resources/ mdq.jsp). In the television advert, we see our heroine logging onto www. bipolarawareness.com and finding this questionnaire. The voice encourages the viewer to follow her example: “Take the test you can take to your doctor, it can change your life….getting a correct diagnosis is the first step in treatingThe Essay section contains opinion pieces on topics of broad interest to a general medical audience.

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DOI: 10.1371/journal.pmed.0030185.g001

Figure 1. Articles Elicited by Medline Using the Mesh Term “Mood Stabilizer”

bipolar disorder. Help your doctor to help you.” This advert markets bipolar disorder. The advert can be read as a genuine attempt to alert people who may be sufferingfrom one of the most debilitating and serious psychiatric diseases—manic-depressive illness. Alternatively, the advert can be read as an example of what has been termed disease mongering [1]. Whichever it is, it will reach beyond those suffering from a mood disorder to others who will as a consequence be more likely to see aspects of their personal experiences in a new way that will lead to medicalconsultations and in a way that will shape the outcome of those consultations. Adverts that encourage “mood watching” risk transforming variations from an emotional even keel into potential indicators of latent or actual bipolar disorder. This advert appeared in 2002 shortly after Lilly’s antipsychotic olanzapine had received a license for treating mania. The company was also running trials aimedat establishing olanzapine as a “mood stabilizer,” one of which was recently published [2].

treated with antidepressants and the manias with antipsychotics or lithium. Lithium was the only agent thought to be prophylactic against further episodes of manic-depressive illness [3]. But lithium was not originally referred to as a mood stabilizer. The term “mood stabilizer” had barely been heard ofbefore 1995 when Abbott Laboratories got a license
Funding: The author received no specific funding to write this article. Competing Interests: DH has been a speaker, consultant, or clinical trialist for Lilly, Janssen, SmithKline Beecham, Pfizer, Astra-Zeneca, LorexSynthelabo, Lundbeck, Organon, Pierre-Fabre, Roche, and Sanofi. He has also been an expert witness in ten legal cases involvingantidepressants and suicide or homicide and one case involving the patent on olanzapine (Zyprexa). None of these interests played any part in the submission or preparation of this paper. Citation: Healy D (2006) The latest mania: Selling bipolar disorder. PLoS Med 3(4): e185. DOI: 10.1371/journal.pmed.0030185 Copyright: © 2006 David Healy. This is an open-access article distributed under the terms of...