France Has the Highest Percentage of Patients Suffering from Depression and Anxiety,
According to New NOP World Health Research
EAST HANOVER, N.J., June 22, 2004 - PRNewswire

You France has the highest proportion of patients suffering from both depression and anxiety, according to NOP World Health's new Western European Depression and Anxiety Physician Study. More than three-quarters of French depression patients (76%) also suffer from some form of anxiety, as opposed to 72% of Spanish patients ... 59% of Italian and British patients ... and 46% of German patients. These new findings reinforce earlier research results, showing that anxiety seems to be under-recognized in Germany. On average, in Europe, 62% of depression patients show symptoms of anxiety disorders. This is comparable to the US, where 60% of depression patients also suffer from anxiety. Overall, depression and anxiety are very prevalent throughout Western Europe, with one in five Europeans affected. Many sufferers are undiagnosed, however -- and even those who are diagnosed are often not treated with prescription medications. This continues to be true, in spite of the fact that many established depression and anxiety therapies are available in Europe -- several in generic form or recently re-launched with new formulations.

Depression Is Most Severe in France, Germany and the US In France and Germany, 41% of depression patients suffer from moderate to severe symptoms. In contrast, just 37% of UK patients and 33% of Spanish and Italian patients show signs of moderate to severe depression. Overall, 37% of Western European depression patients fall into the
moderate or severe category. This is a far lower portion than the US, where 42% of depression sufferers are classified as moderate to severe.

Therapeutic Patterns and Awareness Vary Western European treatment patterns vary from the US. For moderate to
severely depressed patients without anxiety, 65% of Western European physicians first use mono-therapy, while 87% of US doctors opt for single-drug treatment as a first-line therapy. There are significant differences among Western European physicians, however, depending on the countries in which they practice. For instance, in the UK, 93% of doctors turn to mono-therapies first, with only 7% choosing combination therapies. In contrast, just 48% of physicians in Italy use mono-therapy as a first-line treatment, with 49% selecting two- or three-drug combinations.
The biggest difference between Western European doctors and their US counterparts appears to be in product awareness levels, particularly for investigational agents. For example, just 13% of Western European physicians are aware of duloxetine, while more than half of US physicians --51% -- know about it. Awareness levels are lowest in France, where they stand at just 4%. Even in Italy, however -- the country with the highest awareness -- just 24%
of doctors are aware of duloxetine, less than half of the US levels. In part, the differences in awareness of duloxetine can be explained by differences in launch plans for the US and European markets. In the US, Lilly plans to launch duloxetine for depression first -- and then introduce it for stress urinary incontinence (SUI) a year or so later. In Europe, however, Lilly has first submitted duloxetine to the European Medicines Agency for approval in SUI. The dramatic differences in awareness between US and European physicians, however, suggest other forces, such as communication issues, are also at play -- and the result may be untapped potential in the European markets. "The lower awareness levels of Western European doctors, particularly for pipeline agents, may point to new opportunities for pharmaceutical manufacturers," says Keith Loehlein, Senior Vice President of Assessment and Tracking for NOP World Health. "The lower awareness may be tied to the lower prescribing rates for Western European physicians. It points to the need for pharmaceutical companies to communicate more actively with European physicians and to find the messages and media that resonate with this audience. "Clearly, there is a large market for anti-depression and anti-anxiety drugs in the major Western European nations that is not being fully tapped. Our new study, which also looks at unmet market needs and opportunities, as well as at product positioning and use, can help pharmaceutical marketers reach physicians treating depression and anxiety patients and ensure these patients are getting the therapies they need."

600 Physicians Provide Input on Market Needs, Prescribing Patterns and Disease Management Practices Fielded in January and February 2004, NOP World Health's Western European Depression and Anxiety Physician Study is based on in-depth face-to-face interviews with 600 physicians in France, Germany, Italy, Spain and the UK. The sample includes 70 generalists and 50 psychiatrists per country. Information in the Western European study is analyzed both within each individual country and across all countries. It is also presented for both total physicians and by individual specialty group.