1 Table of Contents
1 Table of Contents 10
1.1 List of Tables 15
1.2 List of Figures 20
2 Introduction 22
2.1 Related Reports 22
2.2 Upcoming Related Reports 23
3 Disease Overview 24
3.1 Etiology and Pathophysiology 24
3.1.1 Etiology 24
3.1.2 Pathophysiology 25
3.2 Classification 28
3.3 Symptoms and Subtypes of Major Depressive Disorder 30
3.4 Prognosis 31
3.5 Quality of Life 31
4 Epidemiology 32
4.1 Disease Background 32
4.2 Risk Factors and Comorbidities 33
4.3 Global Trends 35
4.4 Forecast Methodology 38
4.4.1 Sources Used Tables 38
4.4.2 Forecast Assumptions and Methods 40
4.4.3 Sources Not Used 44
4.5 Epidemiological Forecast for MDD (2015-2025) 46
4.5.1 12-Month Total Prevalent Cases of MDD 46
4.5.2 Age-Specific 12-Month Total Prevalent Cases of MDD 48
4.5.3 Sex-Specific 12-Month Total Prevalent Cases of MDD 49
4.5.4 Age-Standardized 12-Month Total Prevalence of MDD 51
4.5.5 12-Month Total Prevalent Cases of MDD by Severity 52
4.6 Discussion 53
4.6.1 Epidemiological Forecast Insight 53
4.6.2 Limitations of the Analysis 54
4.6.3 Strengths of the Analysis 55
5 Disease Management 56
5.1 Diagnosis and Treatment Overview 56
5.1.1 Diagnosis 56
5.1.2 Treatment Guidelines 57
5.1.3 Clinical Practice 59
5.2 US 63
5.3 5EU 66
5.4 Japan 70
6 Competitive Assessment 73
6.1 Overview 73
6.2 Selective Serotonin Reuptake Inhibitors 75
6.2.1 Lexapro (Escitalopram) 75
6.2.2 Viibryd (Vilazodone) 83
6.2.3 Other Selective Serotonin Reuptake Inhibitors 87
6.3 Serotonin-Norepinephrine Reuptake Inhibitors 101
6.3.1 Cymbalta (Duloxetine) 101
6.3.2 Effexor (Venlafaxine) 109
6.3.3 Fetzima (Levomilnacipran) 116
6.3.4 Savella (Milnacipran) 122
6.3.5 Pristiq (Desvenlafaxine) 127
6.4 Multimodal Antidepressants 132
6.4.1 Trintellix (Vortioxetine) 132
6.5 Other Antidepressants 141
6.5.1 Bupropion 141
6.5.2 Symbyax (Olanzapine/Fluoxetine) 147
6.5.3 Mirtazapine 152
6.5.4 Monoamine Oxidase Inhibitors 157
6.5.5 Tricyclic Antidepressants 161
6.6 Antipsychotics 165
6.6.1 Abilify (Aripiprazole) 165
6.6.2 Seroquel XR (Quetiapine XR) 172
6.6.3 Rexulti (Brexpiprazole) 177
6.7 Other Therapeutic Classes 183
7 Unmet Need and Opportunity 184
7.1 Overview 184
7.2 New Therapies with Better Efficacy 186
7.2.1 Unmet Need 186
7.2.2 Gap Analysis 188
7.2.3 Opportunity 189
7.3 Improved Safety Profiles 190
7.3.1 Unmet Need 190
7.3.2 Gap Analysis 192
7.3.3 Opportunity 193
7.4 Rapid Onset of Action 195
7.4.1 Unmet Need 195
7.4.2 Gap Analysis 196
7.4.3 Opportunity 198
7.5 Personalized Treatment Approach 199
7.5.1 Unmet Need 199
7.5.2 Gap Analysis 200
7.5.3 Opportunity 201
7.6 Manage Patient Outcome Expectations 203
7.6.1 Unmet Need 203
7.6.2 Gap Analysis 205
7.6.3 Opportunity 206
8 Pipeline Assessment 208
8.1 Overview 208
8.2 Clinical Trial Mapping 208
8.2.1 Clinical Trials by Class of Therapy 208
8.3 Promising Drugs in Clinical Development 209
8.3.1 ALKS-5461 213
8.3.2 Vraylar (Cariprazine) 222
8.3.3 ASC-01 229
8.3.4 AXS-05 232
8.3.5 Esketamine 239
8.3.6 Rapastinel (GLYX-13) 247
8.3.7 Strada (MSI-195) 255
8.3.8 Viotra (Tramadol) 261
8.4 Promising Drugs in Early-Stage Development 268
8.4.1 CGP3466B 268
8.4.2 NSI-189 269
8.5 Other Drugs in Development 270
9 Current and Future Players 272
9.1 Overview 272
9.2 Trends in Corporate Strategy 274
9.3 Company Profiles 275
9.3.1 Allergan 275
9.3.2 e-Therapeutics 278
9.3.3 Alkermes 280
9.3.4 Pfizer 282
9.3.5 Otsuka 284
9.3.6 Janssen 287
9.3.7 Eli Lilly 290
9.3.8 Lundbeck 292
9.3.9 Takeda 295
9.3.10 Axsome Therapeutics 297
10 Market Outlook 299
10.1 Global Markets 299
10.1.1 Forecast 299
10.1.2 Drivers and Barriers – Global Issues 306
10.2 US 306
10.2.1 Forecast 306
10.2.2 Key Events 309
10.2.3 Drivers and Barriers 310
10.3 5EU 310
10.3.1 Forecast 310
10.3.2 Key Events 315
10.3.3 Drivers and Barriers 316
10.4 Japan 318
10.4.1 Forecast 318
10.4.2 Key Events 320
10.4.3 Drivers and Barriers 321
11 Appendix 322
11.1 Bibliography 322
11.2 Abbreviations 365
11.3 Methodology 371
11.4 Forecasting Methodology 371
11.4.1 Diagnosed MDD Patients 371
11.4.2 Percent Drug-Treated Patients 372
11.4.3 Percent Treatment-Resistant Patients 372
11.4.4 Drugs Included in Each Therapeutic Class 372
11.4.5 Key Launch Dates and Patent Expiries 373
11.4.6 General Pricing Assumptions 373
11.4.7 Individual Drug Assumptions 374
11.4.8 Generic Erosion 384
11.4.9 Pricing of Pipeline Agents 385
11.5 Primary Research – KOLs Interviewed for this Report 386
11.6 Primary Research – High-Prescriber Survey 388
11.7 About the Authors 389
11.7.1 Analysts 389
11.7.2 Therapy Area Director 389
11.7.3 Epidemiologist 390
11.7.4 Global Director of Therapy Analysis and Epidemiology 390
11.8 About GlobalData 391
11.9 Disclaimer 391