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The Difficulties of Living with Depression Don't End with the Illness Itself

This month Mary Assimakopoulos examines some of the insights gathered while surveying 2,000 patients suffering with this often misunderstood mental illness.

On a flight back from the US a few weeks ago I watched the film Side Effects, a recently-released psychological thriller which takes a swipe at the medical profession, big pharma and the treatment of mental health. Manhattan psychiatrist Dr Jonathan Banks’ (Jude Law) world is turned upside down when a patient he treats with a new anti-depressive apparently kills her husband because of the side effects of her medication. Whilst an extreme dramatisation, the film does highlight some of the challenges the healthcare profession faces when treating depression. There is no one ideal treatment or solution - patients typically cycle through a range of prescriptive medicines and therapy until they find a treatment programme that works for them.

In our market research study into depression, conducted amongst 2,000 patients in the USA, Germany and the UK, we undertook a latent class analysis which identified four patient segments. We titled these patient types Apprehensive Annie, Positive Paul, Get-on-with-it Greg and Resigned Rachel. Apprehensive Annie and Resigned Rachel formed the two largest patient segments – comprising 38% and 30% of the sample respectively.

Apprehensive Annie is typically younger and more recently diagnosed. She is more likely to be at the start of the patient journey. Annie is anxious about the future, but she has accepted her diagnosis and is generally positive about her prescription medication, the benefits of therapy and her relationship with her doctor. Resigned Rachel is more likely to be older and have been suffering with depression for a long time, sometimes over 15 years. Rachel has been through many types of medication and is the least satisfied with her current treatment – she does not believe that prescription medication can help her feel normal. Indeed, 14% of the Resigned Rachel segment are currently not receiving any treatment or therapy. Almost three quarters of this segment have missed appointments at some point because they felt worse and didn’t want to go.

When we looked at the range of symptoms these segments experience and the impact on their everyday life, we saw an interesting pattern. Both Resigned Rachel and Apprehensive Annie experience almost all the same symptoms – particularly citing lack of energy, difficulty sleeping and loss of interest in things. However, Resigned Rachel reported experiencing all the same symptoms more acutely than Apprehensive Annie. Similarly, whilst the majority of patients in both segments cite depression as having a major impact on many aspects of life including sleep, motivation, interacting with people, planning for the future, sex drive, work, leisure, family and appetite, Resigned Rachel feels all of these have a bigger impact than Apprehensive Annie.

Comparison of these two segments allowed us to draw some conclusions about the journey experienced by patients with depression and consider the opportunities pharma has to intervene at key stages in order to improve overall outcomes. Let’s take a look at these in turn:

Social support
We asked patients what kind of support they sought and experienced from those around them. Apprehensive Annie and Resigned Rachel have typically told their spouse or partner, family and close friends of their condition. They are both unlikely to have told their employer or work colleagues. However, Apprehensive Annie feels much more supported by those around her than Resigned Rachel. Does this present an opportunity for pharma to help expel the myths surrounding depression and make it easier for people to understand and help people who are living with the condition?

Relationship with doctor
When asked about their relationship with their doctor, Apprehensive Annie clearly has a better experience than Resigned Rachel. Annie agrees more strongly than Resigned Rachel on all statements around the patient/doctor relationship such as:

·         S/he takes my concern seriously
·         S/he gives me the support I need
·         S/he makes sure I understand my treatment
·         S/he listens to me
·         I trust my doctor
·         The doctor goes out of their way to help me

Is there an opportunity here for pharma to support the physician in improving their relationship with the patient? This could be particularly relevant in the early stages of the journey. Our survey found that Resigned Rachel did not have a positive outlook at diagnosis – she was unsure of what the next steps were. Reviewing their condition now, only 14% of patients in the Apprehensive Annie segment feel that their depression is severe compared to 48% at diagnosis. However, 26% of the Resigned Rachel segment feel that their condition is still severe, compared with 55% at diagnosis. Clearly, there is some work to be done here, either in changing perception of the degree of their condition or in altering the trajectory of the patient journey to a more positive state.

Attitude to therapy and treatment program
Finally, we looked at the segments’ attitudes to their medication and therapy in treating their condition. Apprehensive Annie is fairly positive about her current prescription medication and to some extent she feels that it is helping her live life the way she wants it to. Resigned Rachel doesn’t feel that her medication is making a positive impact on her life and doesn’t believe that it makes her feel more “normal”.

Neither of the segments feel particularly positive about therapy, with both wanting a better relationship with their therapist and a better ability to apply the techniques they learnt in everyday life. However, Resigned Rachel is more motivated to attend therapy and Apprehensive Annie does admit to feeling better after therapy. The findings here suggest that pharma could do more to improve expectations around what prescription medications can deliver and to improve the therapy and counseling support that patients with depression are experiencing. The majority of patients from all segments don’t consider their depression to be episodic. Even though they experience periods when their depression has lifted, patients aren’t aware of this and to them it can feel as though they are living with the condition continually for years and years.

The research conducted highlights some of the unmet needs of patients living with depression. Perhaps with new treatments currently in pipeline, pharma has the opportunity to address these needs with a combination of more efficacious prescription medication and improved “around the pill” support.

Published Aug 15, 2013 eyeforpharma.com

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