An Unholy Alliance? Psychiatry and the influence of the pharmaceutical industry PDF Print E-mail
Joanna Moncrieff, 27 June 2006

The use of psychiatric drugs has rocketed over recent years.  Prescriptions of antidepressants, for example, rose by 253% in the ten years up to 2003 (NICE, 2004). In the United States antidepressants are among the top selling classes of prescription drug, with antipsychotics, anti-anxiety agents and stimulants all also ranking highly and/or showing rapidly increasing sales. The pharmaceutical industry has had a major role in creating this situation. Back at the beginning of the era of modern psychopharmacology, industry campaigns helped to establish the use of chlorpromazine (the first neuroleptic or antipsyhotic drug) and antidepressant drugs. More recently commercially funded publicity campaigns have fueled rises in psychotropic drug use. This activity has lead to the pharmaceutical companies being among the most successful companies in the world, their profits far outstripping other commercial sectors.   
Marketing drugs
The amount of money lavished on marketing to psychiatrists is epitomised by the 7th World Congress of Biological Psychiatry held in 2001. Drug companies constructed elaborate installations to attract delegates’ attention, including an artificial garden (Janssen-Cilag), a running stream (Lundbeck), a 40-foot rotating tower (Novartis) and a tent with costumed women offering fortune telling (Organon). At a local level, drug companies lavish free meals and gifts on doctors and increasingly other professionals too. The American Psychiatric Association is said to derive 30% of its annual income from drug company sources (Pfeiffer, 2001).
It has repeatedly been shown that doctors prescribing practices are adversely influenced by interaction with industry representatives and attendance at drug company sponsored events.

Marketing disorders
Drug companies are increasingly marketing disorders themselves. Long before a drug is launched disease awareness campaigns are conducted to "create dissatisfaction in the market", "establish a need" and "create a desire," according to a recent issue of a pharmaceutical industry trade journal (Pharmaceutical Marketing, 2002). "Product champions" and "opinion leaders" are recruited from among the academic community to endorse the campaign and author articles in scientific journals and patient groups are supported or even created.   
Social Anxiety Disorder (SAD) campaigns provide an example. Prior to the campaigns SAD was an uncommon diagnosis for which drug treatment was not generally felt to be helpful. Company sponsored research claimed that it was more common than previously thought. In the United States campaign, Cohn and Wolfe, a public relations agency, employed by the drug company then known as SmithKline, manufacturers of Paxil (paroxetine, or Seroxat in the UK), hired academic psychiatrists and celebrity patients and saturated the media with items about the condition. An apparent patient support group, the Social Anxiety Disorder Coalition was set up, operating out of the offices of Cohn and Wolfe, which disappeared at the end of the campaign. A few months later, SmithKline launched advertisements for Paxil as a treatment for SAD and by the end of the year sales had risen so much that it had become the second best selling antidepressant drug in the United States (Mother Jones, 2002).
Similar industry funded campaigns have concerned Attention Deficit Hyperactivity Disorder (ADHD), Generalised Anxiety Disorder, Panic Disorder, Post Traumatic Stress Disorder, Obsessive Compulsive Disorder and Premenstrual Dysphoric Disorder and, incredibly, "Compulsive buying disorder"!
The industry has also funded campaigns run by professional medical institutions such as the Defeat Depression Campaign conducted in the United Kingdom in the early 1990s (part funded by Eli Lily, makers of Prozac). This campaign aimed to increase the diagnosis of depression. Campaign literature suggested that up to a third of the general population might experience depression at some point in their lives, that 20% of General Practice attendees might have some symptoms of depression and that up to half of these required treatment. The campaign was also concerned to reduce fear of addiction to antidepressants, even though it has now been recognized that they do cause discontinuation reactions. Subsequently, levels of prescribing of antidepressants have increased so dramatically that there is now concern, even in mainstream psychiatry, that they are being over-prescribed.
Concepts of psychosis have also been extended with the popularity of notions such as "early intervention" and preventive treatment. The manufacturers of the new atypical antipsychotic drugs, which have been enormously profitable, have funded conferences, journal supplements and preventive treatment trials. These trials involve starting young people, judged to be at "high risk" of developing psychosis, on low dose antipsychotic drugs. Even the most optimistic estimates suggest that this strategy would mean many young people being started on long-term antipsychotic treatment who would never actually become psychotic. The emphasis that is placed on these ideas also helps to lower thresholds for prescribing antipsychotic drugs generally and makes it more difficult to avoid long-term drug treatment, even though we know that at least some people with psychosis do not benefit from it.

Drug companies increasingly control all aspects of drug research from the design and implementation of a study to the analysis and publication of data. An high proportion of papers, over half in a recent study (Healy & Cattel, 2003), are written by commercial medical writing agencies employed by drug companies, a process known as "ghost writing". Links between academic doctors and the industry also include payment for speaking at conferences, consultancy fees, payment for sitting on boards, and holding equity in a company. In 2000 the New England Journal of Medicine did not have space to print all the financial interests of the authors of a paper on the antidepressant nefazadone and had great difficulty in identifying an academic psychiatrist to write an editorial on the subject who did not have financial ties with companies that make antidepressants.
Drug trials in psychiatry may be particularly susceptible to vested interests. Several authors have described the numerous methodological devices that can distort results, including use of questionable definitions of outcome, masking unfavorable side effects, withholding unfavourable results and masking sponsorship. Recent publications have demonstrated that non publication of negative findings has lead to over-estimates of efficacy of antidepressants in children (Jureidini et al, 2004) and adults (Kirsch et al, 2002).

Impact on mental health care
The current situation in which drugs so dominate psychiatric care does not serve patients’ interests well. Drugs are frequently used where they have not been shown to be effective. Other therapeutic activities have been run down. A report by the Sainsbury Center found that 40% of inpatients in the United Kingdom had no social or recreational activities available to them and that occupational therapy and psychology services for inpatients were very limited. Industry funded research also helps to reinforce recommendations that psychiatric drugs need to be taken long-term. In contrast, methodological problems with the research evidence upon which such recommendations are based, such as the effects of drug discontinuation, have received little attention (Moncrieff, in press). There is also little research into ways of withdrawing patients safely from psychotropic drugs.
The pharmaceutical industry has also played down the risks associated with psychiatric drugs. Eminent psychiatrists have claimed that drug companies attempted to impede publication of the adverse effects of Halcion and sulpiride, for example. Recently, evidence has emerged that drug companies failed to publish data on adverse effects in trials of SSRIs including suicidal behaviour (Whittington et al, 2004). Also literature sponsored by companies producing atypical antipsychotics appears to play down the recognized risk of developing diabetes with some of these drugs (Dinan, 2004).

Biological psychiatry has always been contested.  Although it now seems predominant, social or psychologically based approaches remain popular with patients and many professionals. The pharmaceutical industry helps to promote a biological approach to the understanding of human suffering and its huge financial power can be seen as unfairly tipping the scales. This impoverishes mental health care since challenges to the hegemony of biological psychiatry provide an important incentive to the development of innovative and patient centered services.

The activities of pharmaceutical companies have helped to create a situation whereby psychiatric drugs are prescribed numerously, often for long periods, to the detriment of other approaches and despite emerging doubts about their efficacy in certain situations. The risks of drug treatment have also sometimes been minimized. However there is increasing wariness and criticism of the relationship between medicine and the pharmaceutical industry. Medical journals such as the British Medical Journal have published several exposés and organizations have sprung up which monitor the industry’s activities and campaign to reduce its influence over healthcare (Box 1). The tide may be turning, but there is a long way to go. 
Further Information
Alliance for Human Research Protection, US (
Adverse Psychiatric Reactions Information Link, UK (
Corpwatch, US (
Health Which, UK (
Healthy Skepticism, Australia (
Public Citizen, United States (
Social Audit, UK (

Joanna Moncrieff is Senior Lecturer, Department of Mental Health Sciences,
University College London and Honorary Consultant Psychiatrist,
North East London Mental Health Trust.  email j.moncrieff AT


This paper summarises and updates a Maudsley Discussion Paper, "Is Psychiatry for Sale?" where more references can be found. It is available from the Institute of Psychiatry and at

Dinan TG (Ed) (2004) Schizophrenia and diabetes 2003: an expert consensus meeting. British Journal of Psychiatry 184, Supplement 47.

Healy D & Cattell D (2003) The interface between authorship, industry and science in the domain of therapeutics. British Journal of Psychiatry, 183, 22-27.

Jureidini JN, Doecke CJ, Mansfield PR, Haby MM, Menkes DB, Tonkin AI (2004) Efficacy and safety of antidepressants for children and adolescents. BMJ  328:879-883. 

Kirsch I, Moore TJ, Scoboria A, Nicholls SS (2002) The emperors new drugs: an analyisis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention and Treatment 5,

Moncrieff J (in press) Does antipsychotic withdrawal provoke psychosis? A review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal related relapse. Acta Psychiatrica Scandinavica.

Mother Jones (2002) Disorders made to order. Mother Jones magazine, July/August 2002.

NICE (National Institute for Clinical Excellence) (2004) Depression: management of depression in primary and secondary care. Clinical practice guideline No 23, London: NICE.

Pharmaceutical Marketing (2002) Practical Guides: Medical Education parts I & II. Pharmaceutical Marketing, 2002.

Pfeiffer MB (2001, June 10th) Drug marketing is widespread. Poughkeepsie Journal, pA2.

Whittington CJ, Kendall T, Fonagy P, Cottrell D, Cotgrave A, Boddington E (2004) Selective serotonin re-uptake inhibitors in childhood depression: Systematic review of published versus unpublished data. Lancet 363, 1341-1345.