Patients with Major Depressive Disorders (MDD)

Even among patients with MDD who do respond to a first treatment, as many as two thirds do not recover fully, and continue to experience residual symptoms.1,2 

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.*2


MDD: A Global illness

Depression, or MDD, affects approximately 40.3 million people across Europe, causing substantial disability.

Between the years 2005 and 2015, the number of people living with depression increased by almost a fifth (18.4%)3 and it now represents the leading cause of disability worldwide.4,5

This disability causes a wide range of physical, emotional and cognitive symptoms, including:6,7

  • Depressed mood
  • Loss of pleasure in all/almost all activities 
  • Fatigue and sleep disruption
  • Social withdrawal
  • Difficulties with thinking, concentrating or making decisions 

The management of MDD is in urgent need of reform; at its worst it can be fatal, with
patients at a 20-fold higher risk of suicide than the general population.8​


In 2004, depression cost
Europe approximately
€118 billion.10​

In addition to its effect on patients’ quality of life,11,12 MDD has a significant socio-economic impact on Europe, with the highest number of days absent for any physical or mental disorder.13 This contributes to the substantial costs associated with the condition: in 2004, depression cost Europe approximately €118 billion – roughly 1% of the total economy of Europe.10


The current treatment paradigm

Achieving response and remission in MDD requires patients to wait weeks and even months.14,15​

The impact of lengthy and ineffective treatment

Lengthy and ineffective treatments can prolong patient suffering, reduce expectations
and reinforce negative emotions such as hopelessness.12

A number of factors contribute to this, including:





With MDD patients already at a 20-fold greater risk of suicide than the general population,**8 a delay in finding an effective treatment may prove

Earlier recognition of inadequate treatment response


Remission rates for patients can be as low as 14% and 13% on their third and fourth antidepressant therapies respectively.*2

Helping Patients to step out of MDD

Despite the low levels of remission that patients are currently experiencing after their third and fourth treatments,2 the need to continue to fight and achieve remission is as pressing as ever: acting with urgency to optimise treatment may reduce patient suffering, increase the likelihood of both asymptomatic remission and functional recovery.16-19

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

  1. Early recognition of inadequate response to treatment, which could offer patients the opportunity to achieve improved response and remission rates as soon as possible16,20
  2. Early treatment switch if there is an inadequate response to treatment, which could give patients the opportunity to achieve a meaningful response, and potentially remission, sooner16
  3. Early identification of patients needing specialised care, which may reduce the number of treatment steps needed to achieve response, and ultimately benefit their quality of life21


* 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]).
** Determined by application of Bayes’s Rule, which states that the probability of suicide is equal to the probability of suicide given death (proportionate mortality prevalence) times the probability of death (general mortality prevalence). 


  1. Al-Harbi K et al. Treatment-resistant depression: therapeutic trends, challenges, and future directions. Patient Prefer Adherence 2012; 6: 369-388.
  2. Rush AJ1, Trivedi MH, Wisniewski 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.
  3. World Health Organisation. Depression and Other Common Mental Health Disorders: Global Health Estimates, 2017. Available from: Last accessed September 2018.
  4. World Federation for Mental Health. DEPRESSION: A Global Crisis, 2012. Available from: Last accessed September 2018.
  5. World Health Organisation. Depression Fact Sheet, 2018. Available from Last accessed September 2018.
  6. Diagnostics and statistical manual of mental disorders. Fifth Edition. 2013.
  7. APA. Practice guidelines for the treatment of patients with major depressive disorder. Third edition, 2010.
  8.  Lepine JP, Briley M. The increasing burden of depression.Neuropsychiatr Dis Treat 2011; 7(Suppl 1): 3-7.
  9. Ferrari AJ, Charlson FJ, Norman RE et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013;10(11): e1001547.
  10. Sobocki P, Jönsson B, Angst J et al. Cost of depression in Europe. J Ment Health Policy Econ 2006; 9(2): 87-98.
  11. Anacker C. New Insight Into the Mechanisms of Fast-Acting Antidepressants: What We Learn From Scopolamine. Biol Psychiatry 2018; 83(1): e5-e7.
  12. Leuchter AF, Cook IA, Hunter AM et al. A new paradigm for the prediction of antidepressant treatment response. Dialogues Clin Neurosci 2009; 11(4): 435–446.
  13. Munoz C. recovering usual functioning in depressed patients. Medicographia 2014; 36(4): 501-507.
  14. Machado-Vieira R, Baumann J, Wheeler-Castillo C et al. The Timing of Antidepressant Effects: A Comparison of Diverse Pharmacological and Somatic Treatments. Pharmaceuticals 2010; 3(1): 19-41.
  15. Machado-Vieira R, Salvadore G, Luckenbaugh DA et al. Rapid onset of antidepressant action: a new paradigm in the research and treatment of major depressive disorder. J Clin Psychiatry 2008; 69(6): 946-958.
  16. Oluboka OJ, Katzman MA, Habert J et al. Functional Recovery in Major Depressive Disorder: Providing Early Optimal Treatment for the Individual Patient. Int J Neuropsychopharmacol 2017; 21(2): 128-144.
  17. Gormley N1, O'Leary D, Costello F et al.  First admissions for depression: is the 'no-treatment interval' a critical predictor of time to remission?. J Affect Disord 1999; 54(1-2): 49-54.
  18. Okuda A, Suzuki T, Kishi T et al. Duration of untreated illness and antidepressant fluvoxamine response in major depressive disorder. Psychiatry Clin Neurosci 2010; 64(3): 268-273.
  19. Bukh JD, Bock C, Vinberg M et al. The effect of prolonged duration of untreated depression on antidepressant treatment outcome. J Affect Disord 2013; 145(1): 42-48.
  20. Reid I, Cameron I, MacGillivray S et al. Depression: current approaches to assessment and treatment. Prescriber 2014; 25(4): 16-20.
  21. van Krugten FC, Kaddouri M, Goorden M et al. Indicators of patients with major depressive disorder in need of highly specialized care: A systematic review. PLOS One 2017; 12(2): e0171659.

ITEM CODE: PHEM/ESK/0918/0001 |Date of Preparation: September 2018