The unipolar depression market is crowded and highly genericized. The prominent use of selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin / norepinephrine reuptake inhibitors (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 into 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: 4 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, Gedeon Richter, GlaxoSmithKline, Janssen, Lundbeck, Luye Pharma Group, Otsuka Pharmaceutical, Pfizer, Sage Therapeutics, Shionogi, Sumitomo Dainippon, Sunovion, Takeda

Key drugs: Ansofaxine hydrochloride, 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, zuranolone (SAGE-217)

Table of contents

  • Unipolar Depression - Landscape & Forecast - Disease Landscape & Forecast 2020

Author(s): Joyce Spadafora, ALM; Arava Suresh, M.Pharm; Audreza Das, P.G. Dip. ; Shilpa Thakur

Joyce is a business insights analyst in Decision Resources Group’s central nervous systems and ophthalmology division, where she provides expert insight into commercial aspects of drug development and market sizing across psychiatric and pain indications. She has worked extensively in DRG’s schizophrenia and chronic pain content.

Prior to joining DRG, Joyce spent several years in the biotech industry focused in research and development and in biotech consulting. Her project experience covered indications including psychiatry, pain, infectious diseases, respiratory, and ophthalmology. Beyond my therapeutic and industry knowledge, she holds a Masters in Extension Studies in Psychology from Harvard University and a B.S in Mechanical Engineering with Biology from the Massachusetts Institute of Technology.

Arava Suresh is a Research Associate in oncology team at Decision Resource Group. He is currently engaged in DRG’s flagship product-Oncology Clinical Trial Monitor (OCTM).

Prior to joining DRG as a permanent employee, Suresh was an intern at DRG for a period of nine months. He holds a M.Pharm degree in Pharmaceutical Administration and Management from Manipal Academy of Higher Education (MAHE, Manipal) in India and Bachelor’s in Pharmacy from Jawaharlal Nehru Technological University, Kakinada (India). 

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.

Shilpa Thakur is a medical graduate with a M.P.H 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.


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