Depression Rising (Again): Turning the Corner in Psychiatry’s Most Burdensome Disorder


  • Joel S. Sandler, PhD, Associate Principal, Defined Health


  • Harry Tracy, PhD, Founder and President, NI Research
  • Roger Longman, Chief Executive Officer, Real Endpoints

It is challenging to overstate the burden of clinical depression: a lifetime prevalence of >15% equates to annual direct and indirect costs of >$200 billion and >44k suicides per year the US alone. For all of the millions who suffer from it, the biological underpinnings of clinical depression are still not fully understood. Invaluable as they were, lessons learned from the once immense but now largely genericized class of SSRIs, such as discrete acute and protracted responses to therapy reflecting short- and long-term effects of increased monoamine levels, nonetheless fail to tell the whole story. Recent developments, namely the rapid and potentially robust effects derived from novel therapeutic modalities (NMDA blockers, GABAergic neurosteroids) in historically-intransigent patient populations (treatment-resistant post-partum depression, major depression), may be poised to shift pharmacotherapy algorithms away from a one-size fits all (or doesn’t) empirical model to one in which different therapies are available to address specific high unmet-need patient segments. These new classes would also introduce different methods of administration (IV), market segments (acute care), and pricing/reimbursement models. With several high profile approval decisions and possible launches on the horizon, the stage is thus set for an emerging commercial case characterized by a new wave of effective anti-depressants, an increasingly influential assortment of payers and practitioners with generic but often ineffectual pharmacotherapy options at their disposal, and of course patients with an unabating level of need and strikingly high placebo response-rates. How will it play out, and what are the implications for future practice, investment, and partnering decisions? Join us as we attempt to tackle these questions in what will undoubtedly be an interesting and evolving space for years to come.