The treatment landscape for major depressive disorder (MDD), consists of numerous safe and effective treatment options, many of which are available as inexpensive generics. Therapies to treat MDD span multiple drug classes, most notably selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), while other agents, including the newer-to-market Brintellix (Lundbeck’s vortioxetine), offer distinct mechanisms of action; atypical antipsychotics are typically prescribed for patients with a poor response to antidepressants. Ultimately, given the multitude of drugs available to treat depressive symptoms, coupled with the heterogeneous nature of the patient population, treatment is often a trial-and-error process. As such, the treatment algorithm is complex and highly individualized.

QUESTIONS ANSWERED

  • What are the drivers and constraints influencing physicians’ treatment decisions for MDD across the EU5? How are patients being treated across different lines of therapy?
  • What drives switching to and from specific brands (e.g., Brintellix [Lundbeck], Cymbalta [Eli Lilly])? How has the availability of generic versions of Cymbalta (duloxetine) and Otsuka’s Abilify (aripiprazole) impacted prescribing?
  • To what extent is polypharmacy prescribed for MDD in the EU5 markets, and what are physicians’ preferred drug class combinations?
  • How has use of key MDD therapies changed in the past year, and what changes do physicians expect in their prescribing of these drugs in one year?

PRODUCT DESCRIPTION

Current Treatment: Provides physician insights on prescribing behavior, treatment paths, and the factors and perceptions driving brand usage so you can understand each brand’s performance and improve or defend your competitive position.

Table of contents

  • Unipolar Depression - Current Treatment - Detailed, Expanded Analysis (EU)
    • Key Updates
      • November 2017
      • Introduction to Current Treatment for Unipolar Depression
        • Key Findings
        • Summary Figures
          • Physicians' Drug Class Patient Share by Line of Therapy for MDD, by Country
          • Most Frequently Prescribed Drug Combinations for the Treatment of MDD
          • Percentage of Nonpharmacological Therapies Prescribed, by Country
        • Introduction to Current Treatment and Medical Practice for Unipolar Depression
        • Drugs Included in This Study of Current Treatment of Unipolar Depression
      • Physician Prescribing Practices
        • Key Findings
        • Patient Characteristics
          • Unipolar Depression Is Similar Across Subtype and Age
          • Top Three Comorbidities and Other Attributes in MDD Patients, by Country and Specialty
          • Percentage of MDD Patients Referred by GP/IM to a Psychiatrist, by Country and Stage of Treatment
          • Most European GP/IMs Still Manage the MDD Patients They Had Referred to Psychiatrists
          • Physicians' Definition of TRD by Country and Specialty
          • Percentage of MDD Patients Who Have TRD and/or Have Residual Depressive Symptoms by Country
          • Percentage of MDD Patients Who Are Elderly, by Country and Specialty
          • Percentage of Elderly MDD Patients Who Have TRD and/or Have Residual Depressive Symptoms by Country
        • Treatment Practices
          • Most MDD Patients Are Treated with a Polypharmacy Regimen
          • Overall Treatment Is Initiated Within Three Weeks of MDD Diagnosis
          • Time Between Diagnosis and Treatment Initiation for MDD Patients by Country and Overall
          • Reasons for Not Initiating Treatment for Some MDD Patients by Country, Specialty, and Overall
          • Majority of MDD Patients Receive Pharmacological Treatment
          • Percentage of MDD Patients Prescribed a Pharmacological Therapy by Country
          • Generic Availability Influences an MDD Therapy's Patient Share
          • Patient Share by Product, Country, and Specialty
          • Percentage of MDD Patients Who Are Prescribed the Brand over the Generic for Aripiprazole and Duloxetine, by Country
          • Majority of Physicians Prescribe Therapies for More Than Four Months
          • Treatment Duration by Product, Country, and Specialty
          • Majority of Physicians Prescribe Nonpharmacological Therapies to Their MDD Patients
          • Physicians Mostly Manage Their MDD Patients with SSRIs and SNRIs
          • Majority of MDD Patients Are on First-Line Treatment
          • Distribution of MDD Patients Across All Lines of Therapy by Specialty
          • Physicians Are Equally Inclined to Switch/Add Therapy to Manage Nonresponders
          • Percentage of MDD Patients Progressing from Each Line of Therapy by Country
          • SSRIs and SNRIs are the Most Prescribed Drug Classes for Managing MDD Patients Across the First Three Lines of Therapy
          • Polypharmacy Is a Common Practice to Manage MDD Patients
          • Use of Polypharmacy by Country
        • Persistency and Compliance
          • Therapeutic Compliance Is Not a Significant Treatment Obstacle
          • MDD Patients' Compliance with Their Prescriptions by Drug and Country
          • MDD Patients' Discontinuation Rate with Prescriptions, By Drug and Country
        • Sequencing of Treatment
          • Most Later-Line Patients Are Treated with Branded Therapies
          • Treatment Flow of MDD Patients Switching to Select Therapies, by Country
          • Treatment Flow of MDD Patients Who Discontinued Select Therapies, by Country
        • Recent/Anticipated Changes in Brand Use/Treatment Approach
          • Use of Brintellix Is Anticipated to Modesty Increase in One Year
          • Physicians' Switching Patterns After MDD Patients' Discontinuation of Key Pharmacological Therapies
          • Common Reasons for Discontinuing a Pharmacological Therapy by Country and Specialty
          • Physicians Change in Use of Key Therapies in the Past Year by Country
          • Physicians' Anticipated Change in Use of Key Therapies in One Year By Country
      • Physician Insight on Medical Practice
        • Key Findings
        • Drivers of Treatment Selection
          • Drug Efficacy Most Influences Physicians' Treatment Decisions
          • Primary Reasons for Physicians to Initiate Antidepressant Treatment: Select Drug Classes
          • Physicians Are Heavily Influenced by Efficacy When Prescribing Branded Therapies
          • Influence of Clinical and Nonclinical Factors on Physicians' Decision to Add an Adjunctive Therapy by Country
          • Factors That Influence the Prescription of Select Brands Across the EU5
          • Factors That Influence the Prescription of Select Brands in France
          • Factors That Influence the Prescription of Select Brands in Germany
          • Factors That Influence the Prescription of Select Brands in Italy
          • Factors That Influence the Prescription of Select Brands in Spain
          • Factors That Influence the Prescription of Select Brands in the United Kingdom
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta Across the EU5
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta in France
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta in Germany
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta in Italy
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta in Spain
          • Factors That Influence the Prescription of Branded Abilify and Cymbalta in the United Kingdom
          • Lack of Experience, Insufficient Efficacy, and Market Access Factors Constrain Physician Prescribing of Select MDD Branded Therapies
          • Factors That Constrain the Prescription of Select Brands Across the EU5
          • Physicians Switch Therapies to Try to Improve Efficacy and Response to Therapy
          • Most Common Reasons Why Physicians Switch Their MDD Patients TO Select Therapies
          • Most Common Reasons Why Physicians Switch Their MDD Patients OFF Select Therapies
      • Methodology
        • Primary Market Research Methodology
        • Currently Prescribed Drug Classes for Unipolar Depression Across the EU5 Countries
        • Respondents' Board-Certified Specialty Across Countries
        • Respondents' Primary Practice Location, by Specialty and Country
        • Respondents' Primary Practice by Country
        • Respondents' Length of Clinical Practice by Country
        • Average Number of Physicians' Unipolar Depression Patients by Disease Subtype Managed per Month by Country
      • Appendix
        • Abbreviations
        • Bibliography
        • Primary Market Research
          • Reasons for Not Recommending Nonpharmacological Therapies to MDD Patients

    Author(s): Audreza Das, P.G. Dip.

    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 B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.


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