The World Market for Antidepressants, 2006

1. Executive Summary

1.1 Aims And Scope of Antidepressants, 2006

2. Introduction

2.1 The Global Cost of Depression

2.2 Overview of the Global Antidepressant Market

2.2 The Threat of Generics

3. Disease Background and Treatment Options

3.1 What Is Depression?

3.2 Different Types Of Depression

3.2.1 Major Depressive Disorder (MDD)

3.2.2 Dysthymia

3.2.3 Bipolar Disorder Is Not Depression

3.2.4 Other Types Of Depression

3.3 Causes Of Depression

3.4 Age, Sex and Depressive Disorders

3.4.1 Depression In Women

3.4.2 Depression In Men

3.4.3 Depression In The Elderly

3.5 The Receptor Hypothesis Of Depression

3.5.1 Serotonin

3.5.2 Norepinephrine (Noradrenaline)

3.5.3 Dopamine

3.5.4 Targets For Drug Development

3.6 Anxiety

3.7 Drug Therapies For Depression

3.7.1 Monoamine Oxidase Inhibitors (Maois)

3.7.2 Tricyclic Antidepressants (TCAs)

3.7.3 Selective Serotonin Re-Uptake Inhibitors

3.7.4 Selective Serotonin and Norepinephrine Re-Uptake Inhibitors

3.7.5 Selective Catecholamine Reuptake Inhibitors

3.8 Leading Drugs In The Antidepressant Market and Their Mode Of Action

4. World Antidepressant Market, 2005-2010

4.1 World Revenue Forecast For Leading Antidepressants

4.2 Market Share by Drug

4.3 Patent Issues and Generic Encroachment

4.4 More Sophisticated Marketing is Required to Drive the Market

4.4.1 Regulatory Restraints Limit Marketing Options

4.4.2 Tapping the Untapped - Can Antidepressant Uptake be Increased by Marketing?

4.4.3 New Indications and Off-Label Use Can Extend an Antidepressants Lifetime

4.4.4 Compliance is a Major Concern

4.4.5 New Formulations Will Provide a Small Amount of Protection from Generics

4.4.6 Pricing

4.5 The Psychology of Drug Prescription

4.6 SSRIs Dominate But Will Lose their Majority Market Share by 2010

4.7 SSNRIs Will Increase Their Market Share

4.8 Other Modes of Action Should Hold their Market Share But May Lose Out to New Treatments

4.9 Individual Forecasts For SSRIs

4.9.1 Zoloft (Pfizer)

4.9.2 Paxil/Seroxat (GSk)

4.9.3 Lexapro And Celexa (Lundbeck A/S and Forest Laboratories)

4.9.4 Prozac (Lilly)

4.9.5 Luvox (Astellas Pharma)

4.10 Effexor Is Well-Established But Faces a Challenge from Cymbalta

4.10.1 Effexor (Wyeth)

4.10.2 Cymbalta (Lilly)

4.11 Other Classes of Antidepressants

4.11.1 Wellbutrin (GSK)

4.11.2 Remeron (Azko Nobel)

4.12 The Antidepressant Market Will Become Extremely Dynamic Because of the  Next Generation of Therapies

5. The Global Market by Country

5.1 United States

5.2 Japan - A Model for Market Expansion

5.3 Europe

5.4 Potential Markets Will Be Hard to Find

6. Threats and Unmet Needs in the Antidepressant Market

6.1 SWOT Analysis of the Antidepressant Market

6.2 Reduction in Side Effects

6.3 Treatment Resistant Depression (TRD) is a Large Untapped Market

6.4 The Lag Period Before Drug Effectiveness is a Restraint on Compliance

6.5 Alternative Treatments For Depression Present Possible Threats and Emphasize Unmet Needs

6.5.1 St. Johns Wort

6.5.2 Electroconvulsive Therapy (ECT)

6.5.3 Psychotherapy

6.6 Summary: New Antidepressants Need to Reduce the Lag Time

7. Pipeline Drugs

7.1 Triple Uptake Inhibitors - the Next Step From SSNRIs

7.1.1 (R)-Sibutramine Metabolite (Sepracor)

7.1.2 DOV 216,303 and DOV 21,947 (Merck)

7.1.3 NS2359 and Radafaxine

7.2 5HT Antagonists and Agonists

7.2.1 Gepirone ER

7.2.2 Vilazodone

7.2.3 PRX-00023

7.3 Neurokinin Receptor Antagonists

7.3.1 Saredutant Potentially Offers a New Approach

7.3.2 GSK Has Three NK Receptor Antagonists in Development For Depression

7.4 CRF Antagonists

7.5 Other Approaches May Still Yield Results

7.5.1 Valdoxan

7.5.2 Beta Adrenergic Receptor Agonists (SR 58878)

7.5.3 Monoamine Oxidase Inhibitors

7.6 A Varied And Competitive Pipeline For New Antidepressants

7.7 Are Unmet Needs Likely To Be Met Soon? Valdoxin And Saradutant Are The Most Promising Candidates

8. Conclusion: The Global Antidepressant Market will see a Severe Drop in Revenue

8.1 The Antidepressant Market Faces an Uncertain Future

TABLES

Table 1.1 Leading Drugs in the Antidepressant Market, 2005

Table 2.1 Main Causes of Disability in Disability Adjusted Life Years (DALY) for Adults 15-59, 2002

Table 3.1 Top Ten Antidepressants in the World and their Mode of Action, 2005

Table 4.1 World Revenues ($m) for Antidepressant Drugs, 2003-2010

Table 4.2 Patent Expiry for Antidepressants and Selected Formulations, 2005

Table 4.3 FDA Approved Indications for Antidepressants, 2005

Table 4.4 Patent Expiry for Extended Release Formulations (US patents), 2005

Table 4.5 World Zoloft Revenues ($m), 2003-2010

Table 4.6 World Paxil Revenues ($m), 2003-2010

Table 4.7 World Celexa Revenues ($m), 2003-2010

Table 4.8 World Lexapro Revenues ($m), 2003-2010

Table 4.9 World Prozac Revenues ($m), 2003-2010

Table 4.10 World Luvox Revenues ($m), 2003-2010

Table 4.11 World Effexor Revenues ($m), 2003-2010

Table 4.12 World Cymbalta Revenues ($m), 2003-2010

Table 4.13 World Wellbutrin Revenues ($m), 2003-2010

Table 4.14 World Remeron Revenues ($m), 2003-2010

Table 5.1 US Revenues ($m) for Antidepressants, 2002-2004

Table 5.2 US Prescription Numbers (m) for Antidepressants, 2002-2004

Table 5.3 Percentage of Prescriptions for Generic and Branded Antidepressants (US) 2002-2004

Table 5.4 Average Cost ($/unit) of Antidepressant Prescriptions (US), 2004

Table 5.5 Generic Prescriptions (US) for Leading Antidepressants, 2004

Table 5.6 Generic Revenues (US) for Leading Antidepressants, 2004

Table 6.1 Major Antidepressant Drug Classes and Common Side Effects, 2005

Table 7.1 Triple Uptake Inhibitors in the Developmental Pipeline, 2005

Table 7.2 5HT Agonists in the Developmental Pipeline, 2005

Table 7.3 Neurokinin Receptor Antagonists in the Developmental Pipeline, 2005

Table 7.4 CRF Receptor Antagonists in the Developmental Pipeline, 2005

Table 7.5 Antidepressants with Other Modes of Action in the Developmental Pipeline, 2005

Table 8.1 The Substantial Influence of Patent Loss on the Antidepressant Market, 2005

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FIGURES

Figure 4.1 Total World Revenues for Antidepressants, 2003-2010

Figure 4.2 World Revenues for Leading Antidepressants, 2004 and 2010

Figure 4.3 Market Share (%) for Antidepressants, 2004

Figure 4.4 Market Share (%) for Antidepressants, 2010

Figure 4.5 Cost of Antidepressants, 2005

Figure 4.6 Price Comparison of Branded and Generic Antidepressants, 2005

Figure 4.7 World Market Share (%) by Drug Class, 2004

Figure 4.8 World Market Share (%) by Drug Class, 2010

Figure 4.9 World Revenues ($m) for Zoloft, 2003-2010

Figure 4.10 World Revenues ($m) for Paxil, 2003-2010

Figure 4.11 World Revenues ($m) for Celexa and Lexapro, 2003-2010

Figure 4.12 World Revenues ($m) for Prozac, 2003-2010

Figure 4.13 World Revenues ($m) for Luvox, 2003-2010

Figure 4.14 World Revenues ($m) for Effexor, 2003-2010

Figure 4.15 World Revenues ($m) for Cymbalta, 2003-2010

Figure 4.16 World Revenues ($m) for Wellbutrin, 2003-2010

Figure 4.17 World Revenues ($m) for Remeron, 2003-2010

Figure 4.18 World Market Share (%) by Company, 2004

Figure 4.19 World Market Share (%) by Company, 2010

Figure 5.1 World Revenues ($m) for Antidepressant by Country/Region, 2004

Figure 5.2 Revenues ($m) for US Antidepressants, 2004

Figure 5.3 Prescriptions for US Branded and Generic Antidepressants, 2002-2004

Figure 5.4 US Prescription Trends for Antidepressants, 2002-2004

Figure 5.5 Percentage of US Prescriptions for Generic and Branded Antidepressants, 2002

Figure 5.6 Percentage of US Prescriptions for Generic and Branded Antidepressants, 2004

Figure 5.7 Average Cost ($/unit) of Antidepressants, 2004

Figure 5.8 Willingness to Seek Help for Mental Health Disorders in Europe

Figure 5.9 World Revenue ($m) for Antidepressant by Country in Europe, 2004

Figure 6.1 A SWOT Chart for the Antidepressant Market, 2005

Figure 8.1 Antidepressant Market in Relation to Major Patent Losses, 2004-2010