Major Depressive Disorder (MDD)

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Major depressive disorder (MDD) affects approximately 40.3 million people across Europe,WHO3 as many as 30% of whom do not respond to traditional antidepressant medications.ALH

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

 

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.ALH,RUS

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.*,RUS

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

 

 

MDD: An illness with devastating consequences for patients and their families

MDD is a leading cause of disability worldwide in terms of total years lost due to disability.WHO2

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.WHO3

 

 

How stigma can affect access to treatment in mental health

Studies suggest that many people in Western Europe, including healthcare professionals, still have stigmatising attitudes about mental illness, which is more prevalent in the Western world compared to Asian and African countries.COR

This can make it harder for those suffering with mental health problems to speak about how they're feeling, which can then delay their diagnosis and access to appropriate treatment, as they remain unknown to the healthcare system.

 

 

Initiatives such as #BreakingDepression are working to combat stigma in mental health.

 

 

MDD incurs substantial costs to Europe.OLE

In addition to its effect on patients’ quality of life,ANA,LEU MDD has a significant socio-economic impact, with the highest number of days absent for any physical or mental disorder.MUN Patients who do not achieve remission show higher morbidity, resource use, and productivity losses compared to those in remission.SIC This contributes to the substantial costs associated with the condition: in 2010, these accounted for roughly €92 billion in Europe.**,OLE

 

 

 

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

 

 

 

Severity of MDD

MDD can affect people in different ways, depending on how long they have been suffering with the condition, and the impact it has on their daily life. This can range from a loss of pleasure in activities, to thoughts of taking their own life.DSM

 

The current treatment paradigm

 

Achieving a response or remission in MDD requires patients to wait weeks, and sometimes even months.MAC,MAC2​

 

 

 

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.LEU

 


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

Earlier recognition of inadequate treatment response

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

 

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

 

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,RUS there is still a need to treat with urgency in MDD. With a more urgent approach, treatment could be optimised, to avoid prolonging patient suffering, and increasing the likelihood of both asymptomatic remission, and functional recovery.OLU,GOR,OKU,BUK

 

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


 

 

Identifying patients in need of specialised care

Most mental health conditions are managed in primary care, and resource allocation between primary and secondary care is important to ensure that care is given in the most appropriate setting and that there are effective pathways to specialist care for those who need it.DEH

 

 

For one secondary care unit, it was found 35% of referrals were classified as ‘emergency’ or ‘urgent’, placing a significant financial and administrative demand on these centres, and negatively impacting the level of assessment received by the patient.DEH

 

How long do you typically allow for a patient to respond to a new antidepressant therapy?

 

What do you do in the event of non-response to an antidepressant therapy?

 

What are the biggest challenges with treating MDD patients ?

 

 

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]).RUS

** Based on 'best estimates' derived from systematic literature reviews by panels of experts in epidemiology and health economics. The cost estimation model was populated with national statistics from Eurostat to adjust to 2010 values, converting all local currencies to Euros (€), imputing cost for countries where no data were available, and aggregating country estimates to purchasing power parity- adjusted estimates of the total cost of brain disorders in Europe in 2010.

References

  1. ALH    Al-Harbi K et al. Patient Prefer Adherence 2012; 6: 369-388.
  2. ANA    Anacker C. Biol Psychiatry 2018; 83(1): e5–e7.
  3. APA    Practice guidelines for the treatment of patients with major depressive disorder. Third edition, 2010.
  4. BUK    Bukh J et al. J Affect Disord 2013; 145(1): 42–48.
  5. COR    Corrigan PW, Watson AC. World Psychiatry. 2002; 1(1): 16–20.
  6. DEH    Dehgan A et al. Progress in Neurology and Psychiatry. 2017; 21(3): 22–25.
  7. DSM    Diagnostics and statistical manual of mental disorders. Fifth Edition. 2013.
  8. FER    Ferrari AJ et al. PLoS Med 2013; 10(11): e1001547.
  9. GOR    Gormley N et al. J Affect Disord 1999; 54(1-2): 49–54.
  10. LEP    Lepine JP, Briley M. Neuropsychiatr Dis Treat 2011; 7(Suppl 1): 3–7.
  11. LEU    Leuchter AF et al. Dialogues Clin Neurosci 2009; 11(4): 435–446.
  12. MAC    Machado-Vieira R et al. Pharmaceuticals 2010; 3(1): 19–41.
  13. MAC2    Machado-Vieira R et al. J Clin Psychiatry 2008; 69(6): 946–958.
  14. MUN    Munoz C. Medicographia 2014; 36(4): 501–507.
  15. OKU    Okuda A et al. Psychiatry Clin Neurosci 2010; 64(3): 268–273.
  16. OLE     Olesen J et al. Eur J Neurol 2012; 19(1): 155–62.
  17. OLU    Oluboka O et al. Int J Neuropsychopharmacol 2017; 21(2): 128–144.
  18. REI        Reid I et al. Prescriber 2014; 25(4): 16–20.
  19. RUS    Rush AJ et al. Am J Psychiatry 2006; 163(11): 1905–1917.
  20. SIC        Sicras-Mainar A et al. Gac Sanit 2009; 24(1): 13–19.
  21. TAY    Taylor D et al. The Maudsley Prescribing Guidelines in Psychiatry. 13th Edition. 2018.
  22. VAN    Van Krugten F et al. PLOS One 2017; 12(2): e0171659.
  23. WAN    Wang PS et al. World Psychiatry. 2007; 6(3): 177–185.
  24. WHO2    World Health Organization. Global Health Estimates 2016: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2016. June 2018. Available from: https://bit.ly/2JGH2yL. Last accessed February 2020.
  25. WHO3    World Health Organization. Depression and Other Common Mental Health Disorders: Global Health Estimates, 2017. Available from: https://bit.ly/2Gzn8CJ. Last accessed February 2020.
  26. WHO4    World Health Organization. Gender and women’s mental health. Available from: https://www.who.int/mental_health/prevention/genderwomen/en/. Last accessed February 2020.

ITEM CODE: CP-136345 | DATE OF PREPARATION: February 2020