Stakeholder Insight: Major Depressive Disorder

Summary

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.

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.

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

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

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