The cost of MDD appears well managed, but the burden is greater than ever

MDD = major depressive disorder
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MDD = major depressive disorder

Even before the COVID-19 pandemic, the increased prevalence of major depressive episodes (MDEs) in the United States signaled a rising burden of MDD.1,2 This burden continues to rise with a 3-fold increase in depression symptoms in 2020.3

It’s time to reevaluate how we manage MDD

Early improvement matters

Early improvement within the first 2 weeks of depressive symptom onset was a discriminative predictor for achieving MDD response and remission in previously completed studies.4,5*

In a longitudinal study5†

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With early remission
Patients returned to average normal functioning as early as 6 weeks.
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Without early remission
Patients took up to 1 year to regain average normal functioning.
  • Defining Early Improvement4
  • Defining Early Response5
  • Defining Normal Functioning5
  • Defining Early Remission5
  • *Wagner 2017
  • Cuidad 2012

For patients with MDD, returning to baseline is a primary goal for treatment6

In one study (N=535), patients identified 3 factors as very important to determining remission6‡:
  • Return to usual level of functioning
  • Return to one’s usual normal self
  • Positive mental health such as optimism and self-confidence
of patients achieved within-normal QOL after first-line therapy

From an analysis of 2,280 adults with major depressive disorder treated with a pharmacological therapy

of patients with MDD discontinued treatment within 90 days8

From a retrospective claims analysis from 2013 to 2017

  • Defining normal QOL7
  • Zimmerman 2006
  • §IsHak 2015
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Your MDD patients may have 6x greater remission likelihood with early improvement4

Today’s approach to MDD treatment may result in months to years of lost response and remission time

An analysis of 2 studies suggests that successive treatment failures correlate with lower remission rates and increased direct costs9,10

Remission rates and direct costs by treatment step

Bar graph depicts an analysis of 2 studies that suggests successive treatment failures correlate with lower remission rates and increased direct
Bar graph depicts an analysis of 2 studies that suggests successive treatment failures correlate with lower remission rates and increased direct
Bar graph depicts an analysis of 2 studies that suggests successive treatment failures correlate with lower remission rates and increased direct costs
Bar graph depicts an analysis of 2 studies that suggests successive treatment failures correlate with lower remission rates and increased direct costs
  • Rush AJ, et al, 2006 STAR*D Trial
  • Arnaud A, et al, 2021 Cost Data
Rising cost icon
This comparison suggests that with every treatment tried and failed, the costs of MDD management is likely to rise

Antidepressant use continues to rise in parallel to rates of MDEs with severe impairment

From 2015-20191,2,11

increase in antidepressant use11**
among commercially insured US adults
increase in MDEs with severe impairment2††
among US adults 18 and older
  • Defining Severe Impairment1
  • **2020 Express Scripts Claims Analysis
  • ††2019 National Survey on Drug Use and Health
Mixed data icon
Delaying effective treatment may lower patients’ likelihood of early response and remission5,12,13
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It’s time to reevaluate how we manage MDD


Sage Therapeutics and Biogen have partnered to develop a range of resources.

Journal of Managed Care & Specialty Pharmacy Resource Center
Payer Perspectives in Major Depressive Disorder (MDD)

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References: 1. Substance Abuse and Mental Health Services Administration. Key substance use and mental health indicators in the United States: results from the 2019 national survey on drug use and health. Accessed May 4, 2022. 2. Substance Abuse and Mental Health Services Administration. 2019 NSDUH detailed tables. Accessed May 4, 2022. 3. Ettman C, Cohen GH, Abdalla SM, et al. Persistent depressive symptoms during COVID-19: a national, population-representative, longitudinal study of U.S. adults. Lancet. 2022;5:100091. 4. Wagner S, Engel A, Engelmann J, et al. Early improvement as a resilience signal predicting later remission to antidepressant treatment in patients with major depressive disorder: systematic review and meta-analysis. J Psychiatr Res. 2017;94:96-106. 5. Ciudad A, Álvarez E, Roca M, et al. Early response and remission as predictors of a good outcome of a major depressive episode at 12-month follow-up: a prospective, longitudinal, observational study. J Clin Pyschiatry. 2012;73(2):185-191. 6. Zimmerman M, McGlinchey JB, Posternak MA, Friedman M, Attiullah N, Boerescu D. How should remission from depression be defined? The depressed patient’s perspective. Am J Psychiatry. 2006;163(1):148-150. 7. IsHak WW, Mirocha J, James D, et al. Quality of life in major depressive disorder before/after multiple steps of treatment and one-year follow-up. Manuscript. Acta Psychiatr Scand. 2014;1-20. 8. Arnaud A, Suthoff E, DeRienzo L, et al. Frequent treatment changes in the course of antidepressant therapy: real-world evidence of unmet needs in the pharmacotherapy of major depressive disorder. J Manag Care Spec Pharm. 2019;25(10):S49-S50. Abstract F11. 9. Rush AJ, Trivedi MH, Wisniewski SR, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry. 2006;163(11):1905-1917. 10. Arnaud A, Suthoff E, Tavares RM, Zhang X, Ravindranath AJ. The increasing economic burden with additional steps of pharmacotherapy in major depressive disorder. Pharmacoeconomics. 2021;3(6)9:691-706. 11. Express Scripts. America’s state of mind report. April 16, 2020. Accessed May 4, 2022. 12. Habert J, Katzman MA, Oluboka OJ, et al. Functional recovery in major depressive disorder: focus on early optimized treatment. Prim Care Companion CNS Disord. 2016;18(5). 13. Smagula SF, Butters MA, Anderson SJ, et al. Antidepressant response trajectories and associated clinical prognostic factors among older adults. JAMA Psychiatry. 2015;72(10):1021-1028.