Responsible Public Relations in Mental Health

PR Literacy in the Case of Esketamine as a Miracle Cure for Depression

Abstract

Mental health conditions are projected to become the leading cause of disability worldwide by 2030, according to the World Health Organization. In this context, esketamine has entered the pharmaceutical market as a revolutionary treatment for resistant depression, generating growing interest in both clinical and media spheres. It has often been portrayed as a near-miraculous remedy for persistent depression and suicidal ideation. However, its approval and commercialisation have sparked considerable debate among healthcare professionals, researchers, and public health experts, who call for greater caution and scientific rigour in communicating both its clinical benefits and potential risks.

This study critically analyses the instrumental use of communication practices surrounding esketamine, focusing on public relations (PR) strategies and the resulting media coverage. The lack of consensus within the scientific and medical communities regarding its efficacy and safety has led to informational and communicative disorder, generating confusion among the public. This situation is exacerbated when high-profile media figures, such as Elon Musk, trivialise the drug’s use, downplaying potential adverse effects and contributing to a distorted public perception. The simplification of discourse on social media and digital platforms promotes uninformed consumption, especially in contexts where mental health remains stigmatised and access to care is limited.

Pharmaceutical companies have demonstrated considerable ability to influence public agendas through a blend of PR, marketing, and institutional communication. Agenda-setting theory (McCombs & Shaw, 1972; Carroll & McCombs, 2003) is particularly relevant in explaining how certain interests manage to prioritise specific topics in media coverage. In the case of esketamine, this influence is exercised through meticulously designed PR campaigns that conceal commercial objectives behind the sponsorship of events with a seemingly scientific or socially responsible character.

These practices often operate through the mechanism of media framing (Rodríguez, 2004), steering discourse toward a favourable interpretation of the drug while omitting controversial or inconvenient aspects. In many cases, these events generate publicity (Ibáñez-Hernández et al., 2025): promotional content presented in journalistic formats, which appears as neutral reporting but ultimately serves corporate interests.

A mixed-methods approach was applied in two phases. Firstly, a case study was conducted through content analysis (Simons, 2011; Bernete, 2013; González-Teruel, 2015). Using purposive, non-probabilistic sampling, various events related to mental health and the promotion of esketamine held between 2021 and 2024 were selected. Following Codina (2018) and Codina et al. (2020), Google Alerts was used with keywords such as: depression, esketamine, mental health, solution, and awards. Variables included event type, slogan, core message, explicit mention of the drug (esketamine/Spravato®), and participant profiles (politicians, psychiatrists, healthcare professionals, celebrities, patients, pharmaceutical representatives, academics, journalists, and others).

Secondly, a content analysis was carried out on articles published in the digital editions of Spain’s three most widely read general-interest newspapers: El País, El Mundo, and ABC (AIMC, 2024). Specialist press (health, finance, sport, etc.) and regional publications were excluded. The analysis covered all articles published through March 2024, with no fixed start date due to the novelty of the product.

Findings highlight the pharmaceutical lobby’s capacity to position products within public discourse using events as platforms for legitimation. News stories often appeared simultaneously across outlets, indicating a coordinated strategy. Media coverage was frequently decontextualized, minimising or omitting side effects while promoting the drug’s alleged benefits. Furthermore, a transfer of authority was observed, whereby public figures and recognised experts lent their prestige to the narrative of efficacy and safety without disclosing potential conflicts of interest with the manufacturer.

In conclusion, it is imperative to revisit standards of responsible communication and PR codes of conduct within the healthcare sector. The lack of effective regulation regarding lobbying and public affairs in this domain permits the dissemination of biased messages that influence both public opinion and clinical decision-making. Interdisciplinary collaboration among healthcare professionals, communicators, educators, and ethics experts is essential to foster two key civic competences: mental health literacy and public relations literacy, as proposed by Holladay and Coombs (2013). Strengthening these literacies is vital to combat stigma, ensure informed access to treatment, and resist the manipulative power of media narratives promoting so-called “miracle cures”.