Unmet Medical Needs

Onset of action, drug efficacy, and side-effect profile are the three key unmet needs with current mood disorder therapies according to physicians interviewed in a recent Datamonitor survey (2001). An improvement in general efficacy of the drug was cited as the single most important factor physicians require in new antidepressant medications. It is widely acknowledged that the characteristics of any new entrant into the marketplace should target the areas listed below if they are to maximize their potential uptake.77 The 'ideal' antidepressant drug should: (1) have efficacy in all depressed patients, irrespective of the various subcategories of this mental disorder; (2) have no adverse side effects; (3) have rapid onset of clinical efficacy; (4) be nontoxic when taken in overdose; and (5) have no drug dependence or rebound withdrawal effects.

Approximately 20-35% of patients do not respond to any of the currently available agents and discontinuation rates are high (up to 50% within the first 4 months of treatment), primarily due to side effects related to the sexual dysfunction associated with the SSRIs. ECT is useful, particularly for individuals whose depression is severe or life threatening or who cannot take antidepressant medication. It is often effective in cases where antidepressant medications do not provide sufficient relief of symptoms.51

A variety of antidepressants are often tried before finding the most effective medication or combination of medications, and often the dosage must be increased to be effective. Although some improvement may be seen in the first few weeks, antidepressant medications must be taken regularly for 3-5 weeks (in some instances 8 weeks) before the full therapeutic effect occurs.51 Patient compliance is often the most cited reason to stop medication due to lack of efficacy or adverse effects (Table 7).

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