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.

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.

Reasons to purchase

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?

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

Pharmaceutical Market Research

Stakeholder Insight: Major Depressive Disorder