Antidepressant drug pipeline: What to know

Depression is one of the most common mental disorders in the United States, affecting approximately 6.7% of adults each year, according to the Anxiety and Depression Association of America.

Depression also takes a heavy economic toll. In 2010, the estimated economic burden of depression, including workplace costs, direct costs, and suicide-related costs was $210.5 billion, according to a report published by the Journal of Clinical Psychiatry. Of that $210.5 billion, only 38% of the total costs were due to major depressive disorder (MDD) itself as opposed to comorbid conditions.

“Depression is often a comorbidity with other chronic illnesses, such as heart conditions or cancer, and often is an impediment to managing other chronic illnesses,” says Cynthia Ambres, MD, a partner at KPMG Strategy and a member of the firm’s Global Healthcare Center of Excellence.

Current treatments

Antidepressants are a popular treatment choice. Although they may not cure depression, antidepressants can reduce symptoms, such as low mood, anxiety, and decreased energy.

According to Farrah Wong, PharmD, director of pipeline and drug surveillance at OptumRx, about one in every 10 Americans, aged 12 years and older, takes an antidepressant medication. Of those individuals, more than 60% have been taking it for longer than two years, and 14% take more than one antidepressant.

The main medications used to treat depression include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, bupropion, mirtazapine, and adjunctive therapies such as atypical antipsychotics.

“Despite a large armamentarium of pharmacotherapy used to treat depression, only 60% to 70% of patients with depression respond to antidepressant therapy,” says Wong. “Of those who do not respond, 10% to 30% exhibit treatment-resistant symptoms coupled with difficulties in social and occupational function, decline of physical health, suicidal thoughts, and increased healthcare utilization.”

Patients diagnosed with MDD are defined as having treatment-resistant depression if their depression has failed two or more antidepressant therapies. These patients pose a major therapeutic challenge to mental health experts as they require specialized treatment-resistant management.

The global anxiety disorder and depression treatment market stood at $22.5 billion in 2013 and is expected to decrease to $18.2 billion by 2020, according to a report published by Transparency Market Research. Wong believes that this anticipated slow decline in spend is because of a weak pipeline of novel drugs and an increasing number of generic entries to the market.

Although the market is experiencing diminished spending in antidepressant drugs, insurance coverage is improving. According to Ambres, mental health parity laws have changed how behavioral conditions are covered. The share of total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44% in 1986 to 68% in 2014, according to a study in Health Affairs. 

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