Transcript
ReachMDAnnouncer:
You’re listening to ReachMD. This medical industry feature, titled “The Importance of Pursuing Novel Treatments for Major Depressive Disorder,” is sponsored by Otsuka. Here’s Dr. Aderonke Pederson.
Dr. Pederson:
Welcome to ReachMD. I’m Dr. Aderonke Pederson. I’m a psychiatrist at Massachusetts General Hospital and an Assistant Professor of Psychiatry at Harvard Medical School. Today, I’ll be discussing why it’s so important that we continue seeking out new ways to manage major depressive disorder, or MDD for short.
For a little bit of background, major depressive disorder is a mental health condition that affects millions of Americans.1 And for the past several decades, treatment has consisted mainly of antidepressant therapy and psychotherapy.2,3
However, the outcomes patients experience leave much to be desired. In one meta-analysis, at two months after baseline, about one-third of patients treated with psychotherapy achieved remission. In another analysis of almost 18,000 adults, an estimated 44 percent of participants who self-reported being on at least one antidepressant for a minimum of three months reported remission.4,5
Fifty to 80 percent of patients can expect to see recurrence of symptoms at some point during their lives.6
And those treated with pharmacotherapy experience not only suboptimal efficacy, but also adverse effects.2,5
For patients with moderate or severe major depressive disorder, the mainstay of treatment is antidepressant therapy in tandem with psychotherapy.3,7 But there are many potential barriers to accessing treatment, including cost, an uneven geographic distribution and shortages of mental health care clinicians. There are also several disparities in care that often affect patients in underserved racial and ethnic groups and those of lower socioeconomic status, as well as the LGBTQIA+ community.7,8-10
Additionally, treatment modalities that are considered invasive like transcranial magnetic stimulation and electroconvulsive therapy, or ECT can be especially challenging to access.11,12 For example, ECT involves general anesthesia which requires an escort for the patient after treatment.11
Beyond all that, it’s important to remember that major depressive disorder is comprised of different patient subtypes distinguished by their symptom clusters, biomarkers, and neurocognitive changes.13 And at the present time, we’re not always able to differentiate between those subtypes and provide targeted therapy.13
But we’re making strides in our understanding of major depressive disorder’s pathophysiology in a way that could lead to developing novel treatment modalities, including ones that might target specific subtypes.13
That includes monitoring symptoms and delivering care digitally, which might help address intervention and access to care.14 So it’s a very exciting time for those of us who treat patients with major depressive disorder. Through discovery and innovation, we may be able to better tackle many of the long-standing, unmet needs that our patients with this disorder face.
ReachMD Announcer:
This program was sponsored by Otsuka. If you missed any part of this discussion, visit Industry Features on ReachMD.com, where you can Be Part of the Knowledge.
References:
- National Institute of Mental Health. Major depression. National Institute of Mental Health. July 2023. Accessed November 10, 2023. https://www.nimh.nih.gov/health/statistics/major-depression
- National Institute of Mental Health. Depression. National Institute of Mental Health. September 2023. Accessed November 10, 2023. https://www.nimh.nih.gov/health/topics/depression
- American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, 3rd ed. American Psychiatric Association Publishing. 2010. Accessed November 10, 2023. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- Cuijpers P, Karyotaki E, Ciharova M, et al. The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: A meta-analysis. Acta Psychiatr Scand. 2021;144(3):288-299. doi:10.1111/acps.13335
- Mojtabai R, Amin-Esmaeili M, Spivak S, Olfson M. Remission and treatment augmentation of depression in the United States. J Clin Psychiatry. 2021;82(6). doi:10.4088/JCP.21m13988
- de Klerk-Sluis JM, Huijbers MJ, Locke S, et al. Factors associated with relapse and recurrence of major depressive disorder in patients starting mindfulness-based cognitive therapy. Depress Anxiety. 2022;39(2):113-122. doi:10.1002/da.23220
- Unützer J, Park M. Strategies to improve the management of depression in primary care. Prim Care. 2012;39(2):415-431. doi:10.1016/j.pop.2012.03.010
- Hamzelou J. Brain stimulation might be more invasive than we think. MIT Technology Review. December 23, 2022. Accessed November 10, 2023. https://www.technologyreview.com/2022/12/23/1065862/brain-stimulation-invasive/
- Cabrera LY, Gilbert MMC, Achtyes ED, et al. Jumping through the hoops: Barriers and other ethical concerns regarding the use of psychiatric electroceutical interventions. Psychiatry Res. 2022;313:114612. doi:10.1016/j.psychres.2022.114612
- Blue Cross Blue Shield Association. Racial disparities in diagnosis and treatment of major depression. Blue Cross Blue Shield Association. May 31, 2022. Accessed November 10, 2023. https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/Racial-Disparities-in-Diagnosis-and-Treatment-of-Major-Depression_2.pdf
- American Psychiatric Association. Mental health disparities: LGBTQ. American Psychiatric Association. 2017. Accessed November 10, 2023. https://www.psychiatry.org/File%20Library/Psychiatrists/Cultural-Competency/Mental-Health-Disparities/Mental-Health-Facts-for-LGBTQ.pdf
- Sadowska K. The socioeconomic and racial disparities in mental health care. Stanford J Public Health. 2018;7:16-18.
- Lynall ME, McIntosh AM. The heterogeneity of depression. Am J Psychiatry. 2023;180(10):703-704. doi:10.1176/appi.ajp.20230574
- Darcy AM, Mariano T. DTx and cognitive behavioral therapy: opportunities, benefits, and challenges of an evolving landscape. Psychiatric Times. August 4, 2021. Accessed November 10, 2023. https://www.psychiatrictimes.com/view/dtx-cognitive-behavioral-therapy
January 2024 US.UNB.V.23.00030
