Last month, we started our series on the online reputations of the top 10 DTC-spending brands in Q1 2012 with an overview of the study’s methodology and a brief look at the perception of the 10 drugs overall. If you are in need of a refresher course click here, otherwise continue on for a more in-depth look at the top DTC-spending drug: Cymbalta.



We reviewed 58,524 conversations to determine the analysis in this report.

Of the top 10 advertised drugs in 2012, Cymbalta has the lowest sentiment. Sentiment for Cymbalta is driven by side effects that overshadow benefits. Depression and chronic pain are high-impact conditions and patients and caregivers continue to have questions and seek answers even when they find medications that even somewhat help. Patients have learned to expect that eventually, they might need to seek out new treatments as their bodies become accustomed to their current therapy and it no longer provides the needed benefits.

When patients decide to stop taking Cymbalta because they no longer see benefits, withdrawal can be difficult which exacerbates negativity. Withdrawal concerns are high as patients do not see using medication as a life-long or long-term solution to most problems with the exception of chronic pain. Caregivers can envision patients taking depression medication indefinitely but most patients expect to be able to stop medication at some point. Therefore, withdrawal fears can increase discontinuations as patients feel that the longer they are on the drug, the harder withdrawal will be.

There remains a stigma surrounding both mental health issues as well as chronic pain that can impede use of Cymbalta for those who feel that they would be viewed as a problem at work. So, some patients choose to alter their medication schedule, which impacts the effectiveness of the treatment and potentially leads to dissatisfaction with Cymbalta.

For many patients, Cymbalta has been a life-saver, allowing them to regain control over their lives. For others, the benefits are more modest but as long as the benefits outweigh the side effects, those patients will see Cymbalta in a positive light. Side effects such as weight gain, nausea, some grogginess and decreased libido will be tolerated. However, increased depression or anger, less than expected pain relief, and severe fatigue will likely cause discontinuation even if some benefit is realized.

Depression and chronic pain sufferers who have not found a treatment that works well can be desperate for help and reach out to other patients for experiences that they might be able to use and learn from. They read that Cymbalta works for some and not for others and also read that patients for whom Cymbalta doesn’t work still believe that others should not rule it out as a possible treatment. So the lack of benefit of others is not necessarily a deterrent to trying Cymbalta, which is shown by the drug’s reasonably high sales to advertising spend index. However, withdrawal is the one side effect that is a deterrent for others. Potential patients see withdrawal issues as a reason to not take Cymbalta because the problems with withdrawal last for so long.

Main Issues Contributing to Negative Sentiment

  • Side effects including weight gain, decreased libido, unsettling dreams, nausea that does not diminish, increased depression, increased anger, insomnia, feeling overly tired.
  • Even patients who stay on Cymbalta regularly evaluate whether the benefits continue to outweigh the side effects.
  • Issues when the drug stops working, including withdrawal problems.
  • Costs and insurance coverage issues.
  • Some patients reject their physicians’ recommendations to stay on Cymbalta long term and decide to stop taking the medication and find it difficult to stop.
  • Concern that taking medications for mental health problems might be misunderstood at work.
  • Problems with family life and relationships while on Cymbalta.
  • Nurses and patients worry about drug interactions as many patients with depression have comorbidities and are on several medications including more than one medication for either depression and/or pain.

Main Aspects Contributing to Positive Sentiment

  • Positive impact on neuropathic pain.
  • Effective for patients with fibromyalgia, bipolar disorder and anxiety disorders.
  • Effective in treatment of depression and anxiety with fewer side effects than other drugs for some patients.

Potential Areas of Risk

Negative impact on patient adherence:

  • Patients are making decisions to stop their medication without necessarily discussing their decision with their HCPs based on perceptions of effectiveness and side effects.
  • Patients considering taking Cymbalta can be influenced by the negative experiences of others, especially when the negative sentiment is strong.
  • Potential impact of drug side effects on family and relationships.
  • Fears of stigma of mental health problems and negative impact on career.
  • Drug interaction concerns.
  • Poor communication between patients and HCPs concerning the impact of side effects and the patient perceptions of drug performance.
  • Tendency to mix and layer drugs makes it difficult for patients to distinguish each drug’s performance, benefits and side effects so patients’ decisions to stop a medication may be based on misinformation.

What the Industry Can Do

Many who will read this article will think, “Well, drugs have side effects and there is nothing that can be done with this information.” We would like to offer some practical ideas that we believe the data support where perhaps patients and physicians can meet in the middle and simultaneously benefit the industry, especially in terms of adherence. These are just a few quick thought-provokers. So much more is possible.

  • Help forge a strong patient-physician bond by educating physicians on how to discuss side effects in a manner that acknowledges patient experiences and addresses how to work around them to keep patients on necessary treatment.
    • Patients want to be treated more holistically—as a person, not as a disease.
    • Physicians tend to treat diseases and conditions, especially specialists. Patients want highly knowledgeable physicians, but they also want their physician to listen and take their concerns seriously and on a more equal level.
    • This task may be more suited to nurses or NP/PAs in a physician’s office, but the effort will be rewarded.
  • Help patients bring side effect concerns forward to their physicians for conversations showing them how to “discuss” rather than “complain.” While we believe that the entire industry needs to work towards “Patients First,” patients have a responsibility to also do their share. Our data shows that many want to, but they also want to do work with those they trust and feel trust them.

 Something to Think About—Real Patient Engagement

We often get asked about engaging patients. And with the advent of personalized medicine, we are moving towards a more patient-centric world faster than before. While Wool Labs has an entire course on patient engagement in our regulated industry, we offer this idea as a way to encourage discussion.

  • Allow patient advocates to help bridge the gaps to improve the industry’s reputation in terms of side effects management.
  • We have found in patient communities—where other sufferers or caregivers spend a great deal of time educating other patients on tips and techniques to increase drug tolerability and reduce side effects over time—patients have fewer issues, higher sentiment, an improved perception of their medication, and a strong willingness to remain adherent.

Next month we will dive into the social statuses of Lipitor and Cialis.



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