The unipolar depression market is crowded and highly genericized. The prominent use of SSRIs and, to a lesser extent, SNRIs as early-line treatments contributes to the challenges branded therapies face when entering this market. Newer-to-market brands (e.g., Lundbeck / Takeda’s Trintellix / Brintellix, Lundbeck / Otsuka Pharmaceutical’s Rexulti / Rxulti) largely compete for use in treatment-resistant depression (TRD) patients, who make up one-third of the major depressive disorder population. The most recent entrant to the depression market, Janssen’s Spravato, offers the fastest onset of therapeutic effect among the approved therapies—fulfilling a key unmet need—but its use for TRD is constrained by multiple factors. Because of remaining unmet need, physicians will continue to look to emerging therapies—many of which offer novel mechanisms of action—as potential future treatment options in this market.


  • What factors drive and constrain the use of branded antidepressants and atypical antipsychotics? What branded therapy is expected to experience the greatest commercial success during the forecast period?
  • What clinical role will Spravato (Janssen’s esketamine) play in the treatment of TRD?
  • Given the crowded, highly genericized unipolar depression market, what is the commercial potential of key emerging therapies for unipolar depression?
  • What are the greatest areas of unmet need in the treatment of unipolar depression and how are late-phase emerging therapies expected to address these unmet needs?

Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan

Primary research: Approximately 15 country-specific interviews with thought-leading psychiatrists and PCPs / GPs; supported by survey data collected for this and other DRG research.

Epidemiology: 12-month prevalence of unipolar depression by country, segmented by MDD, minor depression, and dysthymia; diagnosed and drug-treated cases of unipolar depression; 12-month prevalence of MDD by country, segmented by chronic pain status; 12-month prevalence of MDD by country, segmented by treatment-resistant status.

Emerging therapies: Phase III/preregistration: 5 drugs. Coverage of select Phase II and Phase I products.

Market forecast features: 10-year, annualized, drug-level sales and patient share of key unipolar depression therapies from 2019-2029, segmented by brands / generics

Key companies: Allergan, AstraZeneca, Axsome Therapeutics, Fabre-Kramer, Gedeon Richter, GlaxoSmithKline, Janssen, Lundbeck, Otsuka Pharmaceutical, Pfizer, Sage Therapeutics, Shionogi, Sumitomo Dainippon, Sunovion, Takeda

Key drugs: Aripiprazole, bupropion HCl SR/XR, duloxetine, escitalopram, Latuda (lurasidone), quetiapine IR/XR, Rexulti / Rxulti (brexpiprazole), Spravato (esketamine), Trintellix / Brintellix (vortioxetine), venlafaxine IR / XR, Vraylar / Reagila (cariprazine), AXS-05, gepirone ER, SAGE-217 (zuranolone)

Table of contents

  • Disease Landscape & Forecast
    • COVID-19
    • Key Updates
      • April 2020
      • January 2020
    • Market Outlook
      • Key Findings
        • Market Overview
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Unipolar Depression?
        • What Factors Are Constraining the Market for Unipolar Depression?
      • Drug-Class-Specific Trends
        • Selective Serotonin Reuptake Inhibitors
        • Serotonin and Norepinephrine Reuptake Inhibitors
        • Atypical Antipsychotics
        • Mixed Serotonin Modulators
        • Opioid Receptor Modulators
        • NMDA Receptor Modulators
        • Serotonin Agonists
      • Alternative Market Scenario
    • Forecast
      • Market Forecast Assumptions
      • Market Forecast Dashboard
    • Etiology and Pathophysiology
      • Disease Overview
      • Environmental Factors
      • Genetic Factors
      • Key Pathways and Drug Targets
    • Epidemiology Overview
      • Key Findings
      • Epidemiology Populations
        • 12-Month Prevalent Cases of Unipolar Depression
        • Comorbid Chronic Pain in Major Depressive Disorder
        • Treatment-Resistant Depression in MDD
        • Diagnosed 12-Month Prevalent Cases of Unipolar Depression
        • Drug-Treated 12-Month Prevalent Cases of Unipolar Depression
    • Current Treatment Overview
      • Key Findings
      • Treatment Goals
      • Key Current Therapies
        • Overview
        • Selective Serotonin Reuptake Inhibitors
        • Serotonin and Norepinephrine Reuptake Inhibitors
        • Mixed Serotonin Modulators
        • Tricyclic and Tetracyclic Antidepressants
        • Monoamine Oxidase Inhibitors
        • Melatonin Receptor Agonists
        • Atypical Antipsychotics
        • NMDA Receptor Modulators
        • Nonpharmacological Approaches
        • Dopaminergic - Noradrenergic Agents
      • Medical Practice
        • Overview
        • Region-Specific Treatment Practices
    • Unmet Need Overview
      • Current and Future Attainment of Unmet Needs in Unipolar Depression
    • Emerging Therapies Overview
      • Key Findings
        • Key Findings
      • Key Emerging Therapies
        • Notable Developments in the Late-Phase Pipeline for Unipolar Depression
        • GABA Receptor Modulators
        • Opioid Receptor Modulators
        • NMDA Receptor Modulators
        • Serotonin and Norepinephrine Reuptake Inhibitors
        • Serotonin Agonists
      • Early-Phase Pipeline Analysis
      • Key Discontinuations and Failures in Unipolar Depression
    • Access and Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • United States
        • EU5
        • Japan
      • Looking for More?
    • Methodology
      • Bottom-Up Forecasting Overview
        • Patient Populations
        • Drug-Specific Assumptions
      • Bottom-Up Forecast Assumptions
        • General Sources of Data
        • Agents Included in Our Market Analysis
        • General Statements About Pricing
        • Dosing, Days of Therapy, and Compliance
        • Generic Erosion
        • Out-Year Forecasting
        • Emerging Therapy Prices
      • Primary Market Research
        • Experts Interviewed
    • Appendix
      • Unipolar Depression Bibliography

Author(s): Audreza Das, P.G. Dip; Lisa Cloonan, BA; Shilpa Thakur; Shefali Gulati, MBA Pharm

Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her degree in Biotechnology from Birla Institute of Technology, a deemed university and her Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

Lisa joined Decision Resources Group in 2015 as a business insights analyst for the Central Nervous System and Ophthalmology division. In this role, she analyzes the commercial opportunities for pharmacological therapies across the psychiatry space. Prior to joining Decision Resources Group, Lisa spent 6 years in clinical stroke research at Massachusetts General Hospital. While in the clinical research field, Lisa developed an expertise in neuroimaging analysis, as well as authored and co-authored articles on the influence of white matter hyperintensity burden on stroke risk and recovery. Lisa holds bachelor of arts from Connecticut College, where her course work focused on behavioral neuroscience.

Shilpa Thakur is a medical graduate with a from the Postgraduate Institute of Medical Education and Research with a specialization in epidemiology and biostatistics. She specializes in developing epidemiological forecasts for the multiple indications within the DRG syndicated portfolio. Prior to joining Decision Resources, she monitored HIV sentinel surveillance 2016-2017 in Himachal Pradesh. She also has worked on to see the patterns of Antimicrobial resistance in India.  

Shefali Gulati, Associate analyst, is part of the Central Nervous System, Pain, and Ophthalmology team at Decision Resources Group. She is responsible for performing extensive secondary market research and analysis for major pharmaceutical markets. She comes with one year of experience working on multiple client projects revolving around opportunity assessment, competitive landscape, pipeline analysis, and key product profiling. She holds a MBA degree in Pharmaceutical Management from the National Institute of Pharmaceutical Education and Research (NIPER) in India and Bachelor’s in Pharmacy from DIPSAR.

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