According to the latest report published by Credence Research, Inc. “Treatment Resistant Depression Market: Growth, Future Prospects and Competitive Analysis, 2016-2024,” the treatment resistant depression market was valued at US$ 863.9 Mn in 2015, and is expected to reach US$ 1,129.1 Mn by 2024, expanding at a CAGR of 3% from 2016 to 2024.
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Depression is among the most common mental disorders worldwide, affecting approximately 6.7% individuals in the U.S. alone, each year (Anxiety and Depression Association of America). This condition also creates a significant economic burden on the healthcare system. Patients diagnosed with treatment resistant depression has failed two or more antidepressant therapies. Such patients present a critical therapeutic challenge to mental health as this patient group requires specialized TRD management.
The prevalence of treatment resistant depression is substantial in several European and American countries and peaks in the 40 to 60 age group. Females present a substantially high disease burden, accounting to almost twice as their male counterparts. As opined by treatment providers, patients with TRD are found to be twice as likely as those with major depressive disorder to be hospitalized, thus adding to healthcare cost burden for hospitalized treatment resistant depression patients by 5 to 6 times. Therefore, TRD is a major and the most neglected public health issue with an estimated 12 month prevalence of 2% to 3% for Stage 1 TRD and 1.5% to 2% for Stage 2 TRD.
There is a lack of specific approved treatments for TRD and several treatment algorithms have been developed for TRD that also include re-evaluation of initial diagnosis, optimization of initial treatment regimen through switching, augmenting, combination, other mood stabilizers, atypical antipsychotics, thyroid hormones, or monotherapy with second generation antipsychotics. In several treatment guidelines, electroconvulsive therapy is also considered an option for patients with severe TRD.
Inclusion of a second agent is observed to be an appealing strategy in patients who have demonstrated tolerance to initial antidepressant without significant side effects or have reported partial response and/or when a second agent may turn out to be an important additional goal such as treating comorbid condition – ADHD or smoking or a side effect like nausea. The chief drawbacks to augmentation or combination strategies are augmented risk of drug interactions, potential decrement in treatment adherence and cost.
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Open trials and case studies in treatment of patients with unremitted depression have supported combination of SSRI with venlafaxine with agents that have noradrenergic and dopaminergic agonist properties. These agents include bupropion, direct dopamine agonists, and psychostimulants. These agents reportedly have the advantage of bettering common SSRI side effects. Common psychostimulants and/or bupropion, such combinations may treat common morbidities such as ADHD and smoking. Moreover, combinations of modafinil with SSRI and other novel agents have also attracted interest. However, their efficacy as a treatment of TRD and as adjunct to side effect treatment are yet to be established.