Major depressive disorder (MDD) affects approximately 40.3 million people across Europe1, as many as 30% of whom do not respond to traditional antidepressant medications.2

These patients are often left waiting too long before they’re assessed for treatment response, putting them at higher risk of suicide.3,4


How can we get MDD patients back to their former selves?


Even among patients with MDD who do respond to a first antidepressant treatment, as many as two thirds do not recover fully, and continue to experience residual symptoms.2,5

What’s more, the proportion of MDD patients who achieve remission decreases significantly after each treatment failure, from 31% with a second treatment, to 14% with a third, and 13% with a fourth.*,5

It's time to step out of the shadow of MDD.


MDD: A global illness

MDD is a leading cause of disability worldwide in terms of total years lost due to disability.6

Between 2005 and 2015, the number of people living with MDD increased by almost a fifth, and it now affects approximately 40.3 million people.1


In addition to prolonged low mood, MDD causes a wide range of physical, emotional, and cognitive symptoms, including:7,8






MDD is the most
brain disorder
in Europe.

In addition to its effect on patients’ quality of life,4,11 MDD has a significant socio-economic impact on Europe, with the highest number of days absent for any physical or mental disorder.12 Patients who do not achieve remission show higher morbidity, resource use, and productivity losses compared to those in remission.13 This contributes to the substantial costs associated with the condition: in 2004, these accounted for roughly 1% of the total economy of Europe.10 


The current treatment paradigm


Achieving a response or remission in MDD requires patients to wait weeks, and sometimes even months.14,15​



The impact of lengthy and ineffective treatment

Current treatments in MDD have issues in efficacy:

Lengthy and ineffective treatments can prolong patient suffering, reduce expectations, and reinforce negative emotions such as hopelessness.11


With MDD patients already at a 20-fold greater risk of suicide than the general population,3 a delay in finding an effective treatment may prove life-threatening.4

Earlier recognition of inadequate treatment response

Current guidelines recommend waiting 3 to 4 weeks before a change in treatment approach16



For patients on their third and fourth antidepressant therapies, remission rates can be as low as 14% and 13% respectively.*,5


Helping patients step out of the shadow of MDD

Despite the low levels of remission that patients may experience after receiving three, or even four, treatments,5 there is still a need to treat with urgency in MDD. With a more urgent approach, treatment could be optimised, thus avoiding prolonging patient suffering, and increasing the likelihood of both asymptomatic remission, and functional recovery.17-20​

Steps urgently need to be taken to help make achieving this remission a reality, including:



It’s time to step out of the shadow of MDD.

* From a report comparing acute and longer-term treatment outcomes associated with each of four successive steps in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial. Remission was defined as a score of ≤5 on the Quick Inventory of Depressive Symptomatology–Self-Report (QIDS-SR16) (equivalent to ≤7 on the 17-item Hamilton Rating Scale for Depression [HRSD17]).5


  1. World Health Organisation. Depression and Other Common Mental Health Disorders: Global Health Estimates, 2017. Available from: Last accessed June 2019.
  2. Al-Harbi K et al. Patient Prefer Adherence 2012; 6: 369-388.
  3. Lepine JP, Briley M. Neuropsychiatr Dis Treat 2011; 7(Suppl 1): 3-7.
  4. Anacker C. Biol Psychiatry 2018; 83(1): e5-e7.
  5. Rush AJ et al. Am J Psychiatry 2006; 163(11): 1905–1917.
  6. World Health Organization. Global Health Estimates 2016: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2016. June 2018. Available from: Last accessed June 2019.
  7. Diagnostics and statistical manual of mental disorders. Fifth Edition. 2013.
  8. APA. Practice guidelines for the treatment of patients with major depressive disorder. Third edition, 2010.
  9. Ferrari AJ et al. PLoS Med 2013;10(11): e1001547.
  10. Sobocki P et al. J Ment Health Policy Econ 2006; 9(2): 87–98.
  11. Leuchter AF et al. Dialogues Clin Neurosci 2009; 11(4): 435–446.
  12. Munoz C. Medicographia 2014; 36(4): 501–507.
  13. Sicras-Mainar A et al. Gac Sanit 2009; 24(1): 13–19.
  14. Machado-Vieira R et al. Pharmaceuticals 2010; 3(1): 19–41.
  15. Machado-Vieira R et al. J Clin Psychiatry 2008; 69(6): 946–958.
  16. Taylor D et al. The Maudsley Prescribing Guidelines in Psychiatry. 13th Edition. 2018.
  17. Oluboka O et al. Int J Neuropsychopharmacol 2017; 21(2): 128–144.
  18. Gormley N et al. J Affect Disord 1999; 54(1-2): 49–54.
  19. Okuda A et al. Psychiatry Clin Neurosci 2010; 64(3): 268–273.
  20. Bukh J et al. J Affect Disord 2013; 145(1): 42–48.
  21. Reid I et al. Prescriber 2014; 25(4): 16–20.
  22. Van Krugten F et al. PLOS One 2017; 12(2): e0171659.

ITEM CODE: CP-112661 | DATE OF PREPARATION: September 2019