The World Market for Antidepressants, 2006

1. Executive Summary

1.1 Aims And Scope of Antidepressants, 2006

2. Introduction

2.1 The Global Cost of Depression

2.2 Overview of the Global Antidepressant Market

2.2 The Threat of Generics

3. Disease Background and Treatment Options

3.1 What Is Depression?

3.2 Different Types Of Depression

3.2.1 Major Depressive Disorder (MDD)

3.2.2 Dysthymia

3.2.3 Bipolar Disorder Is Not Depression

3.2.4 Other Types Of Depression

3.3 Causes Of Depression

3.4 Age, Sex and Depressive Disorders

3.4.1 Depression In Women

3.4.2 Depression In Men

3.4.3 Depression In The Elderly

3.5 The Receptor Hypothesis Of Depression

3.5.1 Serotonin

3.5.2 Norepinephrine (Noradrenaline)

3.5.3 Dopamine

3.5.4 Targets For Drug Development

3.6 Anxiety

3.7 Drug Therapies For Depression

3.7.1 Monoamine Oxidase Inhibitors (Maois)

3.7.2 Tricyclic Antidepressants (TCAs)

3.7.3 Selective Serotonin Re-Uptake Inhibitors

3.7.4 Selective Serotonin and Norepinephrine Re-Uptake Inhibitors

3.7.5 Selective Catecholamine Reuptake Inhibitors

3.8 Leading Drugs In The Antidepressant Market and Their Mode Of Action

4. World Antidepressant Market, 2005-2010

4.1 World Revenue Forecast For Leading Antidepressants

4.2 Market Share by Drug

4.3 Patent Issues and Generic Encroachment

4.4 More Sophisticated Marketing is Required to Drive the Market

4.4.1 Regulatory Restraints Limit Marketing Options

4.4.2 Tapping the Untapped - Can Antidepressant Uptake be Increased by Marketing?

4.4.3 New Indications and Off-Label Use Can Extend an Antidepressant's Lifetime

4.4.4 Compliance is a Major Concern

4.4.5 New Formulations Will Provide a Small Amount of Protection from Generics

4.4.6 Pricing

4.5 The Psychology of Drug Prescription

4.6 SSRIs Dominate But Will Lose their Majority Market Share by 2010

4.7 SSNRIs Will Increase Their Market Share

4.8 Other Modes of Action Should Hold their Market Share But May Lose Out to New Treatments

4.9 Individual Forecasts For SSRIs

4.9.1 Zoloft (Pfizer)

4.9.2 Paxil/Seroxat (GSk)

4.9.3 Lexapro And Celexa (Lundbeck A/S and Forest Laboratories)

4.9.4 Prozac (Lilly)

4.9.5 Luvox (Astellas Pharma)

4.10 Effexor Is Well-Established But Faces a Challenge from Cymbalta

4.10.1 Effexor (Wyeth)

4.10.2 Cymbalta (Lilly)

4.11 Other Classes of Antidepressants

4.11.1 Wellbutrin (GSK)

4.11.2 Remeron (Azko Nobel)

4.12 The Antidepressant Market Will Become Extremely Dynamic Because of the Next Generation of Therapies

5. The Global Market by Country

5.1 United States

5.2 Japan - A Model for Market Expansion

5.3 Europe

5.4 Potential Markets Will Be Hard to Find

6. Threats and Unmet Needs in the Antidepressant Market

6.1 SWOT Analysis of the Antidepressant Market

6.2 Reduction in Side Effects

6.3 Treatment Resistant Depression (TRD) is a Large Untapped Market

6.4 The Lag Period Before Drug Effectiveness is a Restraint on Compliance

6.5 Alternative Treatments For Depression Present Possible Threats and Emphasize Unmet Needs

6.5.1 St. John's Wort

6.5.2 Electroconvulsive Therapy (ECT)

6.5.3 Psychotherapy

6.6 Summary: New Antidepressants Need to Reduce the Lag Time

7. Pipeline Drugs

7.1 Triple Uptake Inhibitors - the Next Step From SSNRIs

7.1.1 (R)-Sibutramine Metabolite (Sepracor)

7.1.2 DOV 216,303 and DOV 21,947 (Merck)

7.1.3 NS2359 and Radafaxine

7.2 5HT Antagonists and Agonists

7.2.1 Gepirone ER

7.2.2 Vilazodone

7.2.3 PRX-00023

7.3 Neurokinin Receptor Antagonists

7.3.1 Saredutant Potentially Offers a New Approach

7.3.2 GSK Has Three NK Receptor Antagonists in Development For Depression

7.4 CRF Antagonists

7.5 Other Approaches May Still Yield Results

7.5.1 Valdoxan

7.5.2 Beta Adrenergic Receptor Agonists (SR 58878)

7.5.3 Monoamine Oxidase Inhibitors

7.6 A Varied And Competitive Pipeline For New Antidepressants

7.7 Are Unmet Needs Likely To Be Met Soon? Valdoxin And Saradutant Are The Most Promising Candidates

8. Conclusion: The Global Antidepressant Market will see a Severe Drop in Revenue

8.1 The Antidepressant Market Faces an Uncertain Future

LIST OF TABLES
Table 1.1 Leading Drugs in the Antidepressant Market, 2005
Table 2.1 Main Causes of Disability in Disability Adjusted Life Years (DALY) for Adults 15-59, 2002
Table 3.1 Top Ten Antidepressants in the World and their Mode of Action, 2005
Table 4.1 World Revenues ($m) for Antidepressant Drugs, 2003-2010
Table 4.2 Patent Expiry for Antidepressants and Selected Formulations, 2005
Table 4.3 FDA Approved Indications for Antidepressants, 2005
Table 4.4 Patent Expiry for Extended Release Formulations (US patents), 2005
Table 4.5 World Zoloft Revenues ($m), 2003-2010
Table 4.6 World Paxil Revenues ($m), 2003-2010
Table 4.7 World Celexa Revenues ($m), 2003-2010
Table 4.8 World Lexapro Revenues ($m), 2003-2010
Table 4.9 World Prozac Revenues ($m), 2003-2010
Table 4.10 World Luvox Revenues ($m), 2003-2010
Table 4.11 World Effexor Revenues ($m), 2003-2010
Table 4.12 World Cymbalta Revenues ($m), 2003-2010
Table 4.13 World Wellbutrin Revenues ($m), 2003-2010
Table 4.14 World Remeron Revenues ($m), 2003-2010
Table 5.1 US Revenues ($m) for Antidepressants, 2002-2004
Table 5.2 US Prescription Numbers (m) for Antidepressants, 2002-2004
Table 5.3 Percentage of Prescriptions for Generic and Branded Antidepressants (US) 2002-2004
Table 5.4 Average Cost ($/unit) of Antidepressant Prescriptions (US), 2004
Table 5.5 Generic Prescriptions (US) for Leading Antidepressants, 2004
Table 5.6 Generic Revenues (US) for Leading Antidepressants, 2004
Table 6.1 Major Antidepressant Drug Classes and Common Side Effects, 2005
Table 7.1 Triple Uptake Inhibitors in the Developmental Pipeline, 2005
Table 7.2 5HT Agonists in the Developmental Pipeline, 2005
Table 7.3 Neurokinin Receptor Antagonists in the Developmental Pipeline, 2005
Table 7.4 CRF Receptor Antagonists in the Developmental Pipeline, 2005
Table 7.5 Antidepressants with Other Modes of Action in the Developmental Pipeline, 2005
Table 8.1 The Substantial Influence of Patent Loss on the Antidepressant Market, 2005

LIST OF FIGURES
Figure 4.1 Total World Revenues for Antidepressants, 2003-2010
Figure 4.2 World Revenues for Leading Antidepressants, 2004 and 2010
Figure 4.3 Market Share (%) for Antidepressants, 2004
Figure 4.4 Market Share (%) for Antidepressants, 2010
Figure 4.5 Cost of Antidepressants, 2005
Figure 4.6 Price Comparison of Branded and Generic Antidepressants, 2005
Figure 4.7 World Market Share (%) by Drug Class, 2004
Figure 4.8 World Market Share (%) by Drug Class, 2010
Figure 4.9 World Revenues ($m) for Zoloft, 2003-2010
Figure 4.10 World Revenues ($m) for Paxil, 2003-2010
Figure 4.11 World Revenues ($m) for Celexa and Lexapro, 2003-2010
Figure 4.12 World Revenues ($m) for Prozac, 2003-2010
Figure 4.13 World Revenues ($m) for Luvox, 2003-2010
Figure 4.14 World Revenues ($m) for Effexor, 2003-2010
Figure 4.15 World Revenues ($m) for Cymbalta, 2003-2010
Figure 4.16 World Revenues ($m) for Wellbutrin, 2003-2010
Figure 4.17 World Revenues ($m) for Remeron, 2003-2010
Figure 4.18 World Market Share (%) by Company, 2004
Figure 4.19 World Market Share (%) by Company, 2010
Figure 5.1 World Revenues ($m) for Antidepressant by Country/Region, 2004
Figure 5.2 Revenues ($m) for US Antidepressants, 2004
Figure 5.3 Prescriptions for US Branded and Generic Antidepressants, 2002-2004
Figure 5.4 US Prescription Trends for Antidepressants, 2002-2004
Figure 5.5 Percentage of US Prescriptions for Generic and Branded Antidepressants, 2002
Figure 5.6 Percentage of US Prescriptions for Generic and Branded Antidepressants, 2004
Figure 5.7 Average Cost ($/unit) of Antidepressants, 2004
Figure 5.8 Willingness to Seek Help for Mental Health Disorders in Europe
Figure 5.9 World Revenue ($m) for Antidepressant by Country in Europe, 2004
Figure 6.1 A SWOT Chart for the Antidepressant Market, 2005
Figure 8.1 Antidepressant Market in Relation to Major Patent Losses, 2004-2010

Organisations listed:
Alphapharm
Amarin Pharmaceuticals Inc
Astellas Pharma
AstraZeneca
Azko Nobel
Bristol-Myers Squibb
Clinical Data Inc.
Dainippon Pharmaceutical
Eli Lilly
Fabre-Kramer Pharmaceuticals
Forest Laboratories
GSK
Hoffmann-La Roche
IVAX
Johnson & Johnson
Lundbeck A/S
Merck & Co.
Merck KgaA
Neurogen Corp.
Novartis
NPS
Ono Pharma USA Inc
Organon USA
Par Pharmaceutical
Pfizer
Predix Pharmaceuticals
Sanofi-Aventis
Schwabe Pharmaceuticals
Sepracor Inc
Servier
Verispan
Walgreens
Wyeth