Stakeholder Insight: Major Depressive Disorder - Gaining traction among physicians is crucial in an SSRI-dominated market

Introduction

Prescribing trends reveal that the MDD market is receptive to alternative modes of actions at later lines of therapy, while traditional classes dominate earlier lines. Favorable physician perception is crucial in order to maximize uptake into the market, as demonstrated by recent antipsychotic labeling expansions. The clear demonstration of efficacy and tolerability is therefore paramount.
Features and benefits

* Forecasts of major depressive disorder patient population numbers in the seven major markets based on a comprehensive epidemiological review.* Estimated presentation and diagnosis rates, care pathway, and segmentation of depression cases by disease severity, age, and gender.* In-depth analysis of treatment patterns and regimens prescribed for MDD by antidepressant class and line of therapy.* Analysis of 10 key brands, including SSRIs, SNRIs, antipsychotics, and novel antidepressants, based upon physician perception and therapeutic role.* Detailed review of patient outcomes, including progression through lines of therapy, treatment-resistant depression, relapse, and compliance.
Highlights

Although Datamonitor's survey suggests treatment decisions are usually made by psychiatrists, interviewed KOLs suggest that PCPs are actively managing the majority of MDD patients. Understanding the physician type that is most involved with depressed patients is important in tailoring a strong marketing message to a target audience.SSRI usage is by far the highest at first line and decreases at later lines of therapy, in direct contrast all other classes of drugs for MDD. Lexapro is widely perceived by psychiatrists to be the gold standard, possessing the best overall efficacy and tolerability. These were rated as the two most important clinical attributes by psychiatrists.Abilify, being the first antipsychotic to be granted FDA approval for MDD, is highly thought of by US psychiatrists, while EU psychiatrists tend to favor Seroquel, which became the first EC-approved antipsychotic. Physician perception is swayed by regulatory approval, which allows specific marketing and removes barriers to off-label prescription.
Your key questions answered

* How large is the diagnosed major depressive disorder patient population? How do these patients progress through the care pathway?* Which classes of drugs are prescribed the most and what is their most common therapeutic role? How does this change at second- and third-line therapy?* Which factors influence psychiatrists' prescribing decisions the most? How can a product best differentiate itself from the competition?* How have the recent regulatory approvals of Abilify and Seroquel XR influenced the perceptions of psychiatrists?
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Executive Summary
Scope of the analysis
Datamonitor insight into the major depressive disorder market
Related reports
OVERVIEW
Catalyst
Summary
1. INTRODUCTION AND SCOPE
Coverage of the Stakeholder Insight Survey
Country treatment trees
Epidemiology
Patient segmentation and diagnosis
Treatment classes and guidelines
Treatment trends
Prescribing factors and brand assessment
Treatment outcomes
2. COUNTRY TREATMENT TREES
Introduction to treatment trees
US
Japan
France
Germany
Italy
Spain
UK
3. EPIDEMIOLOGY
Introduction
Key findings
Disease definition and diagnosis criteria
Morbidity and mortality of major depressive disorder
Severity
Major depressive disorder in children and adolescents
Global variation and temporal trends of major depressive disorder
Risk factors for major depressive disorder
Age
Gender
Marital status
Unemployment or underemployment and income
Education
Disability and isolation
Personal experiences
Genetics
Co-morbidities of major depressive disorder
Anxiety disorders
Personality disorders
Impulse control disorders
Substance use disorders and smoking
Cardiovascular disease and stroke
Epidemiologic forecasting of major depressive disorder
Sources of epidemiologic data
Description of methods
Results
Current prevalent cases and future trends
Annual growth rate of disease population
Discussion
Strengths and weaknesses of Datamonitor’s epidemiologic projections
Conclusions
4. DIAGNOSIS AND PATIENT SEGMENTATION
Key findings
Presentation and diagnosis
Presentation and diagnosis rates are low, at one third and one half, respectively
Depressed patients are initially first seen in primary care, then may be referred to a psychiatrist
Patient segmentation
Severity
Age
Gender
5. TREATMENT CLASSES AND GUIDELINES
Key findings
Major depressive disorder treatment algorithms
Treatment guidelines aim to improve treatment outcomes but are underused outside of the US
APA provides comprehensive and widely accepted guidelines
Recommendations vary between guidelines, especially for mild depression
NICE's guideline includes cost-benefit assessment
Pharmacological versus non-pharmacological therapy
Choice of treatment modality is key to the treatment outcome
Pharmacological treatments predominate in the management of depression
Regional dynamics
Pharmacological therapy
Selective serotonin reuptake inhibitors
Serotonin and norepinephrine reuptake inhibitors
Antipsychotics
Other antidepressants
Neurostimulation
Neurostimulation for depression is recommended in the major guidelines
Use in the seven major markets is variable
6. TREATMENT TRENDS BY LINE OF THERAPY
Key findings
Overview
Treatment choices vary greatly in different lines of therapy
The number of drugs used in a pharmacotherapy regimen increases at later lines of therapy
First-line therapy
Surveyed psychiatrists state that 90% of their patients receive active therapy at first line
Monotherapy
Combination therapy
Second-line therapy
Around one third of psychiatrists’ patients progress to second-line therapy
Monotherapy
Combination therapy
Third-line therapy
Monotherapy
Combination therapy
7. PRESCRIBING FACTORS AND BRAND ASSESSMENT
Key findings
Factors influencing physician decision making
Summary
Overall efficacy
Overall side-effect profile
Ability to treat treatment-resistant depression
Ability to be used in combination with other products
Recommendation in treatment guidelines
Convenience of dosing and administration
Physician product familiarity
Cost issues
Brand assessment
Interpreting a brand map
Lexapro is versatile and favored in a crowded marketplace
Lexapro/Cipralex (escitalopram; Forest/Lundbeck)
Drug overview
Use by line of therapy
Physician perception
Pristiq (desvenlafaxine; Pfizer)
Drug overview
Use by line of therapy
Physician perception
Cymbalta (duloxetine; Eli Lilly/Shionogi)
Drug overview
Use by line of therapy
Physician perception
Abilify (aripiprazole; Bristol-Myers Squibb/Otsuka)
Drug overview
Physician perception
Seroquel XR (quetiapine extended release; AstraZeneca)
Drug overview
Use by line of therapy
Physician perception
Valdoxan (agomelatine; Servier/Novartis)
Drug overview
Physician perception
Toledomin (milnacipran; Pierre Fabre)
Drug overview
Use by line of therapy
Physician perception
Paxil (paroxetine; GlaxoSmithKline)
Drug overview
Use by line of therapy
Physician perception
Zoloft (sertraline; Pfizer)
Drug overview
Use by line of therapy
Physician perception
Remeron/Reflex (mirtazapine; Merck/Meiji Seika)
Drug overview
Use by line of therapy
Physician perception
8. TREATMENT OUTCOMES
Key findings
Progression
Progression through lines of therapy
Outcome trends
Relapse rates
Treatment-resistant depression
Compliance
BIBLIOGRAPHY
Epidemiology
Publications and online articles
Diagnosis and patient segmentation
Publications and online articles
Treatment classes and guidelines
Publications and online articles
Datamonitor reports and products
Treatment trends by line of therapy
Publications and online articles
Prescribing factors and brand assessment
Publications and online articles
Datamonitor reports and products
Treatment outcomes
Publications and online articles
APPENDIX
Physician research methodology
Physician sample breakdown
The survey questionnaire
Introduction
Section one: diagnosis and patient segmentation
Section two: treatment of major depressive disorder
Section three: product profiles
Demographics
Contributing experts

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