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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