Sage's postpartum depression effort raises awareness—but sparks ire, too

Sage Therapeutics kicked off its campaign "PPD Silence Sucks" at ACOG in May, but it has since faced increased criticism.

It’s an arresting advertising image: a close-up photo of a woman with a baby pacifier in her mouth and a tear rolling down her cheek. The disease awareness campaign from Sage Therapeutics is tagged, “When it comes to postpartum depression, silence sucks.”

The response, on the other hand, has been anything but silent. But engaged responses and online discussions are just what Sage says it intended.

The campaign “PDD Silence Sucks” from Sage Therapeutics, which is developing a treatment for postpartum depression, was launched in May at the annual meeting of the American Congress of Obstetricians and Gynecologists. A Boston-only outdoor campaign with outdoor posters, side-of-the-bus ads and subway car wraps launched for the month of May in recognition of National Maternal Depression Awareness Month.

“The intent of the campaign was to bring awareness and education and provoke a productive discussion around a condition that has been largely stigmatized and ignored,” Ryan Arnold, D.O., Sage's VP of medical affairs, said in an interview about the campaign, media coverage and pushback. The outdoor work in Boston, where Sage is based, was a one-city, one-month pilot project, he said. 

The campaign got off to a smooth start—Sage’s LinkedIn post about its launch garnered 202 likes and three comments, all positive in tone, including two from women not affiliated with Sage. On Facebook, some of the advocacy groups the drugmaker consulted with to develop the campaign, including the National Coalition for Maternal Mental Health and 2020 Mom, also posted positive encouragement.

But on Instagram, Sage’s initial post of the campaign garnered criticism from a woman in Boston who saw the ad on the MBTA and called it "disturbing."

"The conversation is worthwhile, but showing grown women with pacifiers in their mouths is severely misguided and infantilizing,” she wrote, noting that other people she had spoken to in Boston had the same reaction. Sage then engaged her in a back-and-forth discussion explaining its position, and she continued to press her point civilly as well.

That seemed to be the end of the controversy—until mid-June, when a story in Stat noted how the campaign's imagery had “hit a nerve.” That led to broader pickup, with stories from Huffington Post, Vice’s Tonic, Refinery29 and ScaryMommy.com—all sites that are popular with women—which led to more social media commentary from women and PPD sufferers quite critical of the work.

The outcry on Instagram ranged from “so offensive on so many levels” to “which genius marketer came up with ‘let’s shove a pacifier into a crying woman’s mouth to peddle PPD drugs?’ This is horrific.” Sage responded to the commenters with detailed explanations about its intent and beliefs, although the women were generally not having it.

Arnold said the company has been following the commentary closely.

“It has provoked a very interesting discussion online in response to the coverage that it’s received. And in looking at every comment—and we have followed every single comment—the vast majority of commentary is positive. We’re seeing a very good discussion around postpartum depression and how it affects people,” he said.

Web traffic to the site is up, with average views topping more than 1,000 per day, Arnold said. While that could be attributed to people investigating just what the ad campaign is about, he added that Sage has also seen an increase in people clicking through on its advocacy group links and advice on talking to a doctor, with more than 2,500 through last week. Its advocacy group partners confirmed correlating upticks, he said.

When asked whether Sage will continue to use the woman-and-pacifier imagery, he deferred on specifics and simply said the company is evaluating feedback and discussing how to evolve the campaign.

The marketing controversy comes as Sage anticipates results from its phase 3 trial of its severe postpartum treatment brexanalone (Sage-547) in the second half of this year. The company saw initial positive results in a small phase 2 trial last year, more recently published in the Lancet. There are no other FDA-approved treatments specifically for severe postpartum depression.