Big Pharma high on anti-depressants

In mid-August, Tejas Mohite (name changed on request) was diagnosed with depression and put on a treatment of the anti-depressant drug fluoxetine, along with regular counseling.

The past few months saw major changes in Tejas’s behavior, says his mother. His grades dropped, and so did his attention span. He was slowly becoming non-communicative and withdrawing into his shell, as well as displaying aggressive tendencies like getting into fistfights on the slightest provocation.

Tejas is just over 12 years old, a lanky Mumbai lad studying in Class VIII — clearly not someone expected to be depressed to an extent that would call for anti-depressant medication.

But unfortunately, Tejas’s case is not isolated; healthcare experts claim that an increasing number of children, both in India and globally, are falling prey to depression due to factors like parental split (as in Tejas’s case), alcohol or substance abuse, bullying, peer pressure etc.

Arti Sasane, consultant psychiatrist at the Fortis Hiranandani Hospital in Navi Mumbai, says the average age of people being diagnosed with depression has dropped to below 15 years from the mid-20s earlier.

It’s no wonder, then, that the World Health Organization (WHO) predicts that by 2020, depression will be the second-biggest health problem globally, just behind heart disease.
Over 340 million people suffer from depression, says WHO, of which a whopping 56 million are in India — a figure that is way ahead of the estimated 41 million diabetes patients in the country.

The alarming increase in depression cases is changing the dynamics of the pharmaceutical industry. According to data from market intelligence provider IMS Health, three of the top 15 drugs in terms of sales in 2008 were anti-depressants.

The top-selling anti-depressant drugs last year were Abilify from Bristol-Myers Squibb (with sales of $3.1 billion), EffexorXR from Wyeth ($3 billion) and Lexapro from Forest Labs ($2.9 billion).

Furthermore, estimates suggest that the worldwide market for central nervous system (CNS) drugs will expand to $63.9 billion by 2010, and would be dominated by anti-depressants with a market share in excess of 30%.

According to Sujay Shetty, associate director of professional services firm PricewaterhouseCoopers (PwC), anti-depressants have become top money-spinners due to the aggressive marketing strategies of drug makers combined with the therapeutic aspect of these drugs. “In India, as the diagnosis is poor, the market is not very lucrative. But that would change going ahead,” he said.

Another factor contributing to the growth of this segment, which domestic companies like Sun Pharma, Lupin and Dr Reddys hold in prominence, is the recurrent nature of the illness.

According to Sasane from Fortis Hiranandani Hospital, in about 80% of patients, depression may recur three to five years after the first episode is reported. “Hence, longer treatment is advised. Minimum six months to one year of treatment along with counseling is usually given.”

However, anti-depressants as a class — which includes serotonin-norepinephrine reuptake inhibitors (SNRI) like Effexor and selective serotonin reuptake inhibitors (SSRI) like Lexapro — cause acute side effects.

SNRIs have side effects like increase in blood pressure, says Sasane, while SSRIs come with side effects like acidity, nausea and restlessness.

In February 2005, the USFDA (United States Food & Drug Administration, world’s foremost drug-monitoring body) added a ‘black-box warning’ — the agency’s strongest warning — on prescribing anti-depressants to children and teens due to risks like increase in suicidal thoughts.

The warnings emphasize that patients taking anti-depressants should be closely monitored for side effects.

In May 2007, the FDA extended the warnings to young adults aged 18-24 years. 
“This is likely to have an impact on their sales to a certain extent,” says Sarabjit Kour Nangra, vice-president - research, at Angel Broking.