PROZAC PRINT CAMPAIGN

OVERVIEW
Since its introduction in 1987, Prozac’s sales had boomed, generating significant revenue for its manufacturer Eli Lilly and Company. But the success of this new type of antidepressant—a selective serotonin re-uptake inhibitor (SSRI)—soon spawned intense competition in the $4 billion per year antidepressant market. By mid-1996 Prozac’s sales growth was slowing, and drugs such as Zoloft and Paxil were eating into its market share. In response, Lilly initiated a new advertising campaign for Prozac in 1997. The campaign was a radical shift in Lilly’s marketing strategies for the little green pill.
Instead of focusing solely on convincing doctors of the benefits of Prozac for their patients, Lilly reached out directly to consumers for the first time. The Prozac print campaign, which appeared in over 20 general-interest magazines, targeted both adults who suffered from depression and those who shared their lives. The ads used visual metaphors to describe the experience of depression and subsequent recovery through effective treatment and were designed most specifically to reach those who were depressed but had not sought any form of medical assistance.
Lilly selected the Chicago-based advertising firm of Leo Burnett USA to help spread the message to consumers that ‘‘Prozac Can Help.’’ The original ad was a threepage magazine spread that featured sharply contrasting images portraying the darkness experienced by a person suffering from depression and the light that a patient felt when the illness abated. The first page consisted of a gray cloud on a black background accompanied by the line ‘‘Depression Hurts.’’ The opposite page was a vibrant blue with a highly stylized drawing of a yellow sun captioned with the campaign’s signature line: ‘‘Prozac Can Help.’’ Beneath both pictures were six paragraphs of text that described some of the symptoms of depression. The final paragraph encouraged readers to seek medical care if their symptoms matched those described in the ad and closed by stating that ‘‘Prozac has been prescribed for more than 17 million Americans. Chances are someone you know is feeling sunny again because of it. Prozac. Welcome back.’’ The third page contained the disclosure information and product warnings mandated by the Food and Drug Administration (FDA).
In the months following the publication of the initial ad, Lilly released two companion ads. Each featured the same text, and all were thematically similar. One of the new ads substituted a broken vase and a vase holding flowers for the gray cloud and the yellow sun of the original ad. The other, which ran only in November and December 1997, displayed a limp Christmas tree on one page and a sturdy, upright tree on the opposite page. Although the actual execution of the campaign was the work of Leo Burnett, the creative inspiration for the images came from focus groups conducted with depressed patients. Not only did Lilly and Burnett use these groups to evaluate the effectiveness of the proposed campaigns, but the companies actually used ideas generated by the patients themselves. After having patients draw the ‘‘experience of depression and recovery,’’ Burnett used this raw material to design the final campaign.
Although the Prozac print campaign received some criticism for its efforts to influence potential consumers directly, many others praised the campaign for removing some of the stigma attached to depression and mental illness in general. Lilly pronounced itself pleased with the results and doubled its advertising budget for 1998 in order to expand the campaign.

HISTORICAL CONTEXT
Eli Lilly introduced Prozac in 1987. The antidepressant immediately revolutionized the treatment of depression. As the first SSRI, Prozac acted to increase the available levels of the brain chemical serotonin. Not only did the medication have fewer side effects than older classes of antidepressants such as tricyclics, but it also worked remarkably well. By 1996 Prozac had been prescribed to more than 17 million Americans and had achieved $2.36 billion in sales worldwide. It was used to treat bulimia and obsessive-compulsive disorder, as well as depression. Since Prozac accounted for 29 percent of Lilly’s sales by the fourth quarter of 1997, the drug was quite important to Lilly’s continued success.
By the mid-1990s, however, the astronomical growth of Prozac sales had begun to taper off. According to the Chicago Sun-Times, ‘‘sales were no longer growing at previous levels.’’ Lilly’s drug met increasing competition from more recently introduced SSRIs, which eroded Prozac’s dominance of the antidepressant market.
Analysts were also predicting that the burgeoning antidepressant market—which by 1996 was expanding by almost 33 percent annually—would become saturated by the turn of the century. Furthermore, Lilly’s exclusive patent on Prozac was to expire in 2003, at which time generic makers could enter the field, a development that would greatly reduce the drug’s profitability.
In light of these changes, Lilly recognized the necessity of revamping its advertising strategy. Traditionally the company had marketed Prozac in two ways, both of which centered on physicians. The company maintained a vast sales force that traveled ‘‘door-to-door’’ to doctors’ offices. The sales representatives met with both primary care physicians and psychiatrists to explain the benefits of prescribing the medication to their patients and handed out free samples. Lilly also advertised in professional medical journals in hopes of swaying more doctors to prescribe Prozac for depressed patients. Increasingly, though, Lilly—like others in the pharmaceutical industry—realized the incredible potential in targeting patients directly.

TARGET MARKET
The campaign was intended to reach depressed adults and the people closest to them. By 1997 17.5 million Americans suffered from depression, according to Med Ad News. Depression, however, was a seriously underdiagnosed and undertreated illness. Eli Lilly claimed that two out of every three depressed individuals did not receive treatment. By targeting those who were reluctant to seek professional help for their symptoms, the campaign attempted to appeal to a substantial number of people. Victoria Murphy, a spokesperson for Eli Lilly, explained her company’s strategy to the Fort Worth Star-Telegram: ‘‘The goal is very simple: to encourage people suffering from depression to get into treatment.’’
By expanding its advertising focus to include depressed people who had not yet tried its medication, Lilly hoped to see its Prozac sales rise. Mike Grossman, Director of Public Relations for Leo Burnett, saw his project as one of ‘‘assisting people in their depressed stupor to raise their hand for help . . . [T]hey might not recognize their condition or know that help is out there.’’ In order to do so, however, the campaign had to overcome the stigma that surrounded depression and other mental illnesses. The wording of the ads’ text was carefully selected to describe the symptoms of depression in a nonthreatening way: ‘‘So you may have trouble sleeping. Feel unusually sad or irritable. Find it hard to concentrate.
Lose your appetite. Lack energy. Or have trouble feeling pleasure . . . .’’ The ads also sought to dispel some of the prevalent misconceptions and fears about depression. ‘‘[I]t isn’t just feeling down. It’s a real illness with real causes . . . . Some people think you can just will yourself out of a depression. That’s not true.’’ Grossman summed up Burnett’s goal for the ads’ text: ‘‘We wanted it to be dignified.’’
Because the visual elements of the advertisements were inspired by patients’ illustrations of their own feelings about depression and recovery, the campaign clearly intended to connect with depressed readers (or their family members and friends) on an emotional level. The simple yet powerful symbols of darkness and light were developed to be inclusive. ‘‘We wanted patients and depressed people to be able to respond to the ads,’’ said Grossman.

COMPETITION
Eli Lilly’s strategy of appealing directly to consumers indicated that the company had ‘‘decided to fend off competition from other drug companies by going over doctors’ heads and targeting patients,’’ the Chicago Sun-Times reported. By expanding its potential market, Eli Lilly was attempting to reinvigorate flagging sales. When it was first released, Prozac was the only medication of its kind. Both doctors and patients appreciated the drug’s ability to combat depression effectively, in many cases without causing disruptive or dangerous side effects. Over time, though, Prozac’s solitary reign ended. Other pharmaceutical companies began to create and market their own SSRIs. Smith Kline Beecham’s Paxil and Pfizer’s Zoloft competed head-to-head against Prozac in the ‘‘modern antidepressant’’ category. Other SSRIs joined the increasingly crowded field. Effexor, manufactured by American Home Products Corp., and Bristol-Myers Squibb Company’s Serzone began to encroach on Prozac’s territory. In addition, the older tricyclic family of antidepressants continued to be readily prescribed by doctors. Even nonprescription remedies for depression gained adherents. Hypericum, a derivative of the St. John’s wort plant, was touted as the ‘‘natural Prozac.’’ By July 1997 Prozac commanded less than 50 percent of the $4 billion market for ‘‘modern antidepressants’’ that it had previously dominated. Zoloft, introduced in 1992, was gaining in popularity and had captured nearly one-third of this market. In 1997 Zoloft’s global sales grew to $1.51 billion, while thirdranked Paxil topped $1.45 billion. Prozac’s sales for that year totaled $2.56 billion. Recognizing these developments, the Wall Street Journal Europe declared in 1996 that ‘‘the king of antidepressants is under attack.’’
Claiming that its medication had fewer side effects than Prozac, Pfizer marketed Zoloft aggressively. Indeed, Pfizer’s sales force outmaneuvered Lilly’s, visiting almost 70,000 more doctors’ offices in 1996 than the Lilly team. In the process, Pfizer’s sales representatives passed out many Zoloft samples to these physicians, who in turn dispensed them to depressed patients. Pfizer also placed advertisements in medical journals that implicitly reminded doctors of Prozac’s drawbacks, especially the fact that it was reputed to provoke anxiety in some patients. ‘‘Consider Safety. Consider Effectiveness. Consider Zoloft . . .,’’ the ads suggested. The fact that Pfizer priced Zoloft 20 percent below Prozac also contributed to that drug’s rapid rise by attracting costcutting Health Maintenance Organizations.
While its market dominance was being eroded, Lilly, like a number of other drug companies, took notice of a new development in medical advertising. Rogaine (an anti-hair loss product) and Nicoderm (a smoking cessation aid) had realized tremendous gains in profitability thanks to direct-to-consumer television campaigns run in 1994. These campaigns sparked a broader trend toward direct-to-consumer marketing of an array of pharmaceutical products. Peter Labadie of William-Labadie Advertising told the Chicago Tribune that this shift ‘‘started with hair replacement products. Marketers felt that advertising was moving the products.’’ Thus, in addition to increasing its sales force and promoting Prozac more strongly to primary care physicians, Lilly embarked on its own direct-to-consumer print campaign in an effort to outflank its competitors. This was the first such effort that Lilly had made on behalf of Prozac. At the time, it was also the largest direct-to-consumer campaign for a ‘‘modern antidepressant.’’ American Home Products Corp. had run a regional campaign for Effexor that featured tributes to the powers of the medication (‘‘I got my marriage back,’’ declared one), but Lilly’s Prozac campaign appeared nationwide.

MARKETING STRATEGY
After Eli Lilly chose Leo Burnett to create its direct-to consumer campaign, the ad agency devised a number of possible ads. The one that was best received by patients in Lilly focus groups was, not surprisingly, the series partially inspired by the experiences of patients. The dual metaphorical images of dark and light accurately expressed to them what depression and a return to health felt like. Lilly also sought input from doctors and mental health advocacy groups before releasing the original ad to the public.
In order to reach a large and varied group of people, Lilly chose to run the campaign in general-interest magazines with wide circulations. The ad first appeared in 20 such publications, including Family Circle, Good Housekeeping, Sports Illustrated, Cosmopolitan, Men’s Health, Newsweek, Time, Parade Magazine, and Entertainment Weekly. In keeping with data indicating that the incidence of depression among women was twice as high as that among men, the magazine list was ‘‘skewed toward women,’’ according to Grossman. As Med Ad News pointed out, women accounted for 60 percent of doctor visits and were twice as likely as men to request a specific brand of medication.
Lilly selected a print medium in part because of limitations that the FDA had placed on direct-to-consumer television ads. Regulations in force at the time prohibited pharmaceutical companies from drawing an explicit connection between a medical condition and a medication. Print ads, which were not circumscribed by such restrictions, were therefore a better way for Lilly to convey its message to consumers. Moreover, consumers had more time to reflect on a print ad then on a 30-second television spot, which was ideal for Lilly’s purposes.
Indeed, according to the Indianapolis Star, the ad encouraged the reader to muse actively over symptoms. As Gary Mitchell, a professor at the Indiana University Medical Center, told the Indianapolis Star, ‘‘You’re on Paxil and you see the Prozac ad, and ask yourself, ‘Why am I not on that drug?’
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OUTCOME
Although it is difficult to correlate sales increases to the campaign, Lilly expressed pleasure with the results. In fact, the company announced to Health News Daily that it was doubling its 1998 advertising budget in order to obtain ‘‘a full year effect’’ from the campaign. Industry analyst Myron Holubiak took a clearer stance on the effect of advertising in The Commercial Appeal: ‘‘That drug companies are creating a demand through consumer advertising can be proven, and physicians will prescribe drugs their patients ask for.’’ Prozac’s sales rose 9 percent in 1997 to reach $2.56 billion; 1997 fourth quarter earnings were up 15 percent.
Not everyone, however, approved of Lilly’s direct-to consumer efforts. The American Medical Association condemned all advertising that targeted patients. Erik Parens’ column in the Washington Post was indicative of the outcry directed at the Prozac campaign. ‘‘Of course, doctors can—and should—say no to anyone who doesn’t need a particular medication. But let’s not fool ourselves:
If doctors are under pressure from their patients to prescribe a particular medication, they must become strong gatekeepers to prevent misuse.’’
Despite the negative response from some columnists and consumer advocacy groups, a great many doctors and mental health alliances praised the campaign’s efforts to educate a large number of individuals who suffered, undiagnosed and untreated, from an often debilitating illness.