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Published by: Datamonitor
Published: Apr. 18, 2003 - 168 Pages
Table of Contents
CHAPTER 1 Executive summary
. Scope
. Datamonitor insight into the treatment of major depressive disorder
. Key metrics
CHAPTER 2 EPIDEMIOLOGY OVERVIEW
. Introduction
. Epidemiology of MDD across the seven major markets
Prevalence of MDD in the general population
Prevalence of MDD in the primary care setting
Prevalence of MDD in the psychiatry setting
. Comorbid disorders with MDD
CHAPTER 3 ISSUES SURROUNDING THE DIAGNOSIS OF
MDD
. Diagnosis rate of MDD
Misdiagnosis of MDD
Masked depression
. Severity of depression
Severity of depression upon presentation
Impact of severity on treatment choice
Use of St. John’s Wort
Commercial impact on depresion severity
Dosing
Severity lucrativity
Age/severity market position
. Specialists diagnosing MDD
CHAPTER 4 TREATMENT OF MDD
. Introduction
. Pharmacotherapy treatment parameters
. Overview of pharmacotherapy use
Introduction
First-line choice
US
Japan
EU
CHAPTER 5 SEROTONERGIC DRUG PROFILES
. Introduction
. Zoloft (sertraline)
Overview
Country-specific prescription rates
Physician-perceived drug profile
Response rate
Switching rate
. Paxil (paroxetine)
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Celexa (citalopram)
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Lexapro (escitalopram)
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Prozac (fluoxetine)
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Luvox (fluvoxamine)
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
CHAPTER 6 NORADRENERGIC DRUG PROFILES
. Overview
. Venlafaxine/XR
Overview
Country-specific prescription rates
Physician-perceived drug profile
Response rate
Switching rates
. Remeron
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Edronax
Overview
Country-specific prescription rates
Physician-perceived drug profile
Response rate
Switching rate
CHAPTER 7 TCA, AND NOVEL DRUG PROFILES
. Tricyclic antidepressants
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
. Wellbutrin
Overview
Country-specific prescription rate
Physician-perceived drug profile
Response rate
Switching rate
CHAPTER 8 DRUG SWITCHING AND COMBINATION
THERAPY
. Introduction
. Drug switching
Drug-specific switching rate
Paxil/Wellbutrin—case study
Length of treatment before switching
Commercial analysis
. Combination therapy
Prevalence of combination therapy
Combination with antipsychotics
Zyprexa (olanzapine)
Risperdal (risperidone)
Solian (amisulpride)
Other antipsychotics
Combination with anticonvulsants
Depakote (valproate)
Tegretol (carbamazapine)
Neurontin (gabapentin)
Combination with other psychotropics
Benzodiazepines
Lithobid (lithium)
Ritalin (methylphenidate)
CHAPTER 9 UNMET NEEDS AND TREATMENT REFRACTORY
DEPRESSION
. Introduction
. Physician ratings of unmet needs in depression
Discussion of unmet needs
Efficacy of current drugs
Side effects of current drugs
Onset of action of current drugs
Treatment of refractory depression (TRD)
Ability to maintain depression remission
Compliance of current drugs
Ability to treat comorbid disorders
Cost of current drugs
Drug delivery of current antidepressants
. Treatment resistant depression
Definition
Prevalence
Risk factors
Non-pharmacological strategies
Electroconvulsive therapy (ECT)
Vagus nerve stimulation
Appendix A—ABOUT THE REPORT
. Contributing experts
. Table of tables
. Table of figures
. Websites
. Bibliography
CHAPTER 10 APPENDIX B: ABOUT DATAMONITOR
. About Datamonitor
About Datamonitor Healthcare
Datamonitor Healthcare’s research and analysis methodologies
. Datamonitor Healthcare’s therapy area capabilities
About CNS analysis team
Datamonitor Healthcare’s Consulting expertise
Datamonitor’s Therapeutic Consulting expertise
Key therapy team members
Simon Hemsworth, Director of Therapy Area Analysis
Dr. Susanne Begley, Head of Central Nervous System Business Unit
David Abramson, Therapeutic Lead Consultant
John Freeman, US Lead Consultant
Nick Alcock, Managing Analyst, Central Nervous System
Adam Wickes, Analyst, Central Nervous System
Disclaimer
Table 1: Impact of Wellbutrin on the number of Paxil patients and GSK’s antidepressant portfolio, 2003
Table 2: Population of diagnosed and drug treated major depressive disorder patients, 2003
Table 3: Adult depression prevalence rate, 2003
Table 4: Zoloft: key facts
Table 5: Paxil: key facts
Table 6: Celexa: key facts
Table 7: Lexapro: key facts
Table 8: Prozac: key facts
Table 9: Luvox: key facts
Table 10: Effexor: key facts
Table 11: Remeron: key facts
Table 12: Vestra: key facts
Table 13: TCAs: key facts
Table 14: Wellbutrin: key facts
Table 15: Impact of Wellbutrin on the number of Paxil patients and GSK’s antidepressant portfolio, 2003
Table 16: Case study example: impact of length of first-line treatment regimen on the number of days of Paxil therapy in the Us and Japan
Table 17: The response rates of other antipsychotics used in combination with antidepressants, 2003
Table 18: Physician rating of response rates of benzodiazepines when used in combination with antidepressants, 2003
Table 19: Major depressive disorder patient segment focus of methylphenidate studies, 2003
Table 20: Physician interview sample breakdown
Figure 1: Physician rating of unmet needs in major depressive disorder, 2003
Figure 2: Physician perceived prevalence of major depressive disorder in the seven major markets, 2003
Figure 3: Study and physician defined major depressive disorder patient population over the age of 19 years old, 2003
Figure 4: Prevalence of major depressive disorder in the secondary care setting, 2002
Figure 5: Diagnosis rate of major depressive disorder in adults and pediatrics in the seven major markets, 2003
Figure 6: Severity of depression patients upon presentation, 2003
Figure 7: Major depressive disorder diagnosing medical professional, 2002
Figure 8: Proportion of major depressive disorder patients treated with pharmacotherapy and psychotherapy, 2002
Figure 9: The number of days between diagnosis and treatment of depression, 2003
Figure 10: Average length of antidepressant therpy across the seven major markets, 2003
Figure 11: Physician rating of factors affecting choice of first-line antidepressant, 2003
Figure 12: Proportion of major depressive disorder patients at each line of therapy prescribed sertraline, 2003
Figure 13: Physician rating of sertraline clinical features compared to the serotonergic mean, 2003
Figure 14: Patients response rate to sertraline at specific therapy lines, 2003
Figure 15: Proportion of major depressive disorder patients at each line of therapy prescribed paroxetine, 2003
Figure 16: Physician rating of paroxetine clinical features compared to the serotonergic mean, 2003
Figure 17: Patients response rate to paroxetine at specific therapy lines, 2003
Figure 18: Proportion of major depressive disorder patients at each line of therapy prescribed citalopram, 2003
Figure 19: Physician rating of citalopram clinical features compared to the serotonergic mean, 2003
Figure 20: Patients response rate to citalopram at specific therapy lines, 2003
Figure 21: Proportion of major depressive disorder patients at each line of therapy prescribed escitalopram, 2003
Figure 22: Physician rating of escitalopram clinical features compared to the serotonergic mean, 2003
Figure 23: Patients response rate to escitalopram at specific therapy lines, 2003
Figure 24: Proportion of major depressive disorder patients at each line of therapy prescribed fluoxetine, 2003
Figure 25: Physician rating of fluoxetine clinical features compared to the serotonergic mean, 2003
Figure 26: Patients response rate to fluoxetine at specific therapy lines, 2003
Figure 27: Proportion of major depressive disorder patients at each line of therapy prescribed fluvoxamine, 2003
Figure 28: Physician rating of fluvoxamine clinical features compared to the serotonergic mean, 2003
Figure 29: Patients response rate to fluvoxamine at specific therapy lines, 2003
Figure 30: Proportion of major depressive disorder patients at each line of therapy prescribed venlafaxine/XR, 2003
Figure 31: Physician rating of venlafaxine clinical features compared to the noradrenergic mean, 2003
Figure 32: Physician rating of venlafaxine XR clinical features compared to the noradrenergic mean, 2003
Figure 33: Patients response rate to venlafaxine/XR at specific therapy lines, 2003
Figure 34: Proportion of major depressive disorder patients at each line of therapy prescribed mirtazapine, 2003
Figure 35: Physician rating of mirtazapine clinical features compared to the noradrenergic mean, 2003
Figure 36: Patients response rate to mirtazapine at specific therapy lines, 2003
Figure 37: Proportion of major depressive disorder patients at each line of therapy prescribed reboxetine, 2002
Figure 38: Physician rating of reboxetine clinical features compared to the noradrenergic mean, 2003
Figure 39: Patients response rate to reboxetine at specific therapy lines, 2003
Figure 40: Proportion of major depressive disorder patients at each line of therapy prescribed a TCA, 2002
Figure 41: Physician rating of the TCA class clinical features compared to the antidepressant mean, 2003
Figure 42: Patients response rate to TCAs at specific therapy lines compared to serotonergics and noradrenergics, 2003
Figure 43: Proportion of US major depressive disorder patients at each line of therapy prescribed Wellbutrin/SR, 2003
Figure 44: Physician rating of Wellbutrin’s (bupropion) clinical features compared to the antidepressant mean, 2003
Figure 45: Physician rating of Wellbutrin SR’s (bupropion) clinical features compared to the antidepressant mean, 2003
Figure 46: Patients response rate to Wellbutrin/SR (bupropion) at specific therapy lines, 2003
Figure 47: Effect of response rates and switch rates on Wellbutrin/SR treatment populations, 2003
Figure 48: Switching rates from antidepressants, 2003
Figure 49: A case study of US first-line patients who switch from Paxil, showing the probability of their second-line therapy, 2003
Figure 50: Number of weeks that patients take a drug at a given therapy line, 2003
Figure 51: Proportion of patients prescribed combination therapy, 2003
Figure 52: The level of antidepressant/antipsychotic combination therapy in major depressive disorder patients in 2003
Figure 53: Shows the rate of combination of antidepressants and specific anticonvulsant, 2003
Figure 54: Shows the rate of combination of antidepressants and specific psychotropic, 2002
Figure 55: Unmet needs in depression, 2003
Figure 56: Clinical competitiveness of antidepressants in the anxiety markets, 2003
Figure 57: Physician rating of drug cost being an unmet need, 2003
Figure 58: Proportion of major depressive disorder patients that are treatment resistant, 2003
Figure 59: Potential risk factors for treatment-resistant depression, 2002
Figure 60: Proportion of major depressive disorder patients treated with electroconvulsive therapy (%)
AbstractIntroduction
The treatment strategy of major depressive disorder (MDD) is changing. As primary care physicians gain more experience with antidepressants, referrals, principally to psychiatrists, are decreasing. Moreover, patients who are being referred have normally been prescribed, and not responded to, two appropriate MDD treatments. Hence, referred patents are usually treatment refractory.
Scope
Basded on interviews with 220 psychiatrists from across the seven major markets
Analysis of treatment strategies, including factors affecting drug choice, switching strategy and treatment length
Detailed profiles of antidepressants, their prescription trends across the seven major markets, and physician perceptions of each drug
Key data and analysis of combination therapy - rate of drugs used and the patient segments to which they are prescribed
Report Highlights
Datamonitor’s interviewed psychiatrists rated drug efficacy level as the key unmet need in MDD, but improving this parameter is difficult because of the complexity of antidepressant’s therapeutic action. However, there is some scope to widen the symptoms that antidepressants treat by manufacturing drugs that interact with additional receptors
Combination therapy is an effective strategy to treat various symptoms associated with MDD. Antipsychotics are often combined with antidepressants, with Lilly’s Zyprexa (olanzapine) being the most commonly used, in 8.1% of MDD patients.
Reasons to Purchase
Enhance your knowledge of the antidepressant market by understanding how physicians perceive specific drugs
Target diagnosing specialists and drug prescribers by using Datamonitor primary data on diagnosing specialists and referral rates
Understand the market unmet needs to devise market-penetrating strategies
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