Market Outlook

Despite the broad availability of antidepressants and atypical antipsychotics approved to treat major depressive disorder (MDD), approximately one-third of these patients are treatment resistant (i.e., MDD patients who do not respond to two adequate course of antidepressants). The prevalence of treatment-resistant depression (TRD) has contributed to psychiatrists’ off-label use of ketamine (an anesthetic that can induce depressive symptom relief in TRD patients within hours of treatment administration) and to development of treatments with novel mechanisms of action that can address this cohort of patients’ depressive symptoms and provide rapid relief. Understanding psychiatrists’ clinical use of ketamine and expected use of late-phase emerging fast-acting antidepressants will help drug developers determine which clinical attributes their agents should target and future positioning in this market.

Questions Answered

  • When and why do psychiatrists introduce the different formulations of ketamine (e.g., intranasal, intravenous) into their patients’ treatment paradigm? What are the obstacles to use of each formulation?
  • How long are patients typically treated with select formulations of ketamine? What percentage of patients discontinue ketamine treatment and why?
  • Is ketamine typically prescribed in combination with other therapies? If so, what pharmacological and/or nonpharmacological treatments are prescribed in combination with ketamine?
  • To which of their MDD patients do psychiatrists anticipate prescribing the emerging therapies esketamine (Janssen) and rapastinel (Allergan)?

Additional Tools Available

  • Primary market research survey available to download.

Markets covered: United States

Primary research: Survey of 100 psychiatrists in United States

Key companies: Janssen, Allergan

Key drugs: ketamine, esketamine (Janssen), rapastinel (Allergan)

Key insights provided:

  • Physician-reported ketamine treatment practices.
  • Factors influencing use of ketamine.
  • Physician-reported access and reimbursement related to ketamine.
  • Expected use patterns for emerging fast-acting antidepressants in MDD, including in patients with imminent risk of suicide.

Table of contents

  • Unipolar Depression - Current Treatment - Special Topics (US): Fast-Acting Antidepressants: Ketamine And Ketamine-Like Products
    • Special Topics - Unipolar Depression (Fast-Acting Antidepressants - Ketamine and Ketamine-Like Products) US
    • Executive Summary
      • Background
      • Key Findings
      • Percentage of Patients Receiving Ketamine by Subtype
      • Factors Constraining Psychiatrists' Use of Ketamine for the Treatment of MDD

Author(s): Lisa Cloonan, BA

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.

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