Market Report Source

Overview

Introduction
Major Depressive Disorder (MDD) is estimated to affect over 34 million individuals yearly across the seven major markets. Only a fraction of this patient population is treated adequately, resulting in lost productivity, unnecessary patient suffering and unfulfilled revenue potential for manufacturers.

Scope
Analysis of a survey of 180 prescribing physicians in the seven major markets as well as in-depth interviews with Key Opinion Leaders
Detailed treatment trees showing the prevalence, diagnosis and treatment rates of Major Depressive Disorder across the seven major markets
Discussion of the influence of treatment guidelines on physicians
Insight into diagnostic and therapeutic unmet needs, and recommendations to aid market penetration and maximize prescription rates
Highlights
Individuals with milder forms of MDD are unlikely to present to physicians. Across the seven major markets, only around a half of individuals are then accurately diagnosed at first presentation.

Despite safety concerns surrounding some of the newer antidepressants, the prescribing habits of physicians have changed little, suggesting that the concerns may have been over-hyped.

Cymbalta (duloxetine) is at risk of being seen as a ‘me-too’ SNRI. Datamonitor’s primary research suggests that by focusing on the treatment of painful physical symptoms of depression, Lilly might be missing the drug’s more significant advantages.

Reasons to Purchase
Identify which healthcare professional is responsible for treating patients with differing severities of MDD, allowing for efficient product marketing
Ascertain the preferred and most frequently prescribed drugs for first and second-line therapy, gaining key insight into the competitive landscape
Identify unmet needs to enhance development and market penetration strategies of MDD drugs

Table of Contents

TABLE OF CONTENTS

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the Major Depressive Disorder (MDD) market

Individuals with milder forms of Major Depressive Disorder are unlikely to present to physicians. Across the seven major markets, only around a half of individuals are then accurately diagnosed at first presentation.

The safety concerns surrounding antidepressants have been over-hyped and are not generally shared by physicians.

Cymbalta (duloxetine) is at risk of being seen as a ‘me-too’ SNRI. Datamonitor’s primary research suggests that by focusing on the treatment of painful physical symptoms of depression, Lilly might be missing the drug’s more significant advantages.

CHAPTER 2 INTRODUCTION AND SCOPE

Coverage of the Stakeholder Insight survey – MDD

Epidemiology

Presentation and diagnosis

Treatment of Major Depressive Disorder

CHAPTER 3 COUNTRY TREATMENT TREES

CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION OF MDD

Major Depressive Disorder: definitions and classification

Diagnostic criteria of MDD

DSM-IV

ICD-10

Severity

Dysthymic disorder is a milder form of depression

Etiology of Major Depressive Disorder

Epidemiology of MDD

Prevalence of MDD

Segmentation of MDD

Prevalence of MDD subtypes

Comorbidities

Anxiety

Cancer and other serious illnesses can be accompanied by depression

Heart disease

Diabetes

Neurodegenerative diseases

CHAPTER 5 PRESENTATION & REFERRAL

Presentation rates for milder forms of MDD are low suggesting a significant untreated patient population may exist

The PCP is the first contact for the majority of MDD patients

PCPs opt to refer the patients as MDD severity increases

Greater patient awareness may result in greater numbers seeking help

Further use of internet-based screeners could increase presentation rates.

CHAPTER 6 DIAGNOSIS OF MDD

A number of diagnostic tools are available to ensure correct diagnosis on presentation

WHO-Five Well-being Index provides a useful screener for the suspected depression

The Major Depression Inventory is recommended for use in diagnosing MDD

Clinical trials or epidemiological studies require more advanced diagnostic tools

The Hamilton Rating Scale for Depression (HAM-D) is the gold standard used in clinical trials.

The CIDI is favored for epidemiologic studies

Diagnosis of MDD can be confused with bipolar disorder

Diagnosis rate of MDD

Interviewed physicians ask about the key symptoms when making a diagnosis of MDD.

Painful physical symptoms are often associated with depression

CHAPTER 7 TREATMENT GUIDELINES

Treatment guidelines aim to improve treatment outcomes but are underused outside of the US.

Updates to the APA guideline cover recent issues.

The NICE guideline includes cost-benefit assessment.

CHAPTER 8 TREATMENTS AVAILABLE

Choice of treatment modality is key to the treatment outcome

Treatments already tried depend on the severity of depression

Treatments chosen by interviewed physicians

Drug class overview

MAOIs and TCAs—effective but potentially unsafe.

SSRIs avoid the problems of earlier antidepressants.

Prozac (fluoxetine)

Zoloft (sertraline)

Celexa (citalopram)

Lexapro (escitalopram)

Luvox (fluvoxamine)

Paxil (paroxetine)

SNRIs have added a new layer of available treatment options

Effexor (venlafaxine)

Cymbalta (duloxetine)

Other drugs have proven effective in treating MDD

Wellbutrin (bupropion)

Remeron (mirtazapine)

Ixel (milnacipran)

Edronax (reboxetine)

Serzone (nefazodone)

St.John’s Wort (Hypericum perforatum)

Non-pharmacological treatment overview

Psychotherapy

Cognitive behavioral therapy

Electroconvulsive therapy (ECT)

CHAPTER 9 PRESCRIBING TRENDS

Choice of prescribed drug class

TCAs and SSRIs are prescribed to the majority of patients

Choice of prescribed drugs

Drug choices by US physicians

Key prescribing trends in the US

Drug choices by physicians in Japan

Key prescribing trends in Japan

Drug choices by physicians in France

Key prescribing trends in France

Drug choices by physicians in Germany

Key prescribing trends in Germany

Drug choices by physicians in Italy

Key prescribing trends in Italy

Drug choices by physicians in Spain

Key prescribing trends in Spain

Drug choices by UK physicians

Key prescribing trends in the UK

First-line to second-line progression

Second to third line progression

Reasons for switching treatment

CHAPTER 10 FACTORS INFLUENCING PRESCRIBING TRENDS

Choice of therapy – drug attributes

Efficacy

Side effects

Sexual dysfunction

Weight gain

Sleep problems

GI effects

Safety profile

Risk of suicide

Cardiovascular (CV) risks

Warnings given to patients

Comorbid anxiety

Ability to treat painful physical symptoms of depression

Other factors

Branded versus generic

CHAPTER 11 IMPROVING TREATMENT OUTCOMES

Optimum duration of therapy

Remission and relapse

Proportion of patients achieving remission

Time to achieve remission

Proportion of patients who relapse during remission

Unmet needs

APPENDIX A

Bibliography

Websites

APPENDIX B

Physician research methodology

Physician sample breakdown

US

Japan

France

Germany

Spain

Italy

UK

Physician questionnaire

APPENDIX C

About Datamonitor

About Datamonitor Healthcare

About the CNS analysis team

Disclaimer