Antidepressants hide "specialization and specialty"

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It has been nearly a month since the Russian-Ukrainian conflict broke out. There are news that sales of antidepressants in related areas have soared.

Emo will be anxious for a long time, and the network may be really prone to depression after a long time.

There are 350 million people with depression worldwide. Due to the large population base, Chinese patients account for 1/5. Sullivan, a consulting firm, predicts that the size of China's antidepressant market will be 18.41 billion yuan in 2022.

Directly through the Beijing Stock Exchange, it was found that this market also hides a lot of "specialization and specialty"

01

One summer 42 years ago, Arthur Kleinman, a medical professor at Harvard University, came to Xiangya Hospital in Changsha, Hunan Province.

As the first Western scholar to study psychiatry in China after the founding of the People's Republic of China, Arthur Kleiman found that "neurasthenia" is the most common diagnosis in the psychiatric outpatient clinic of Xiangya Hospital.

In a week,361 patients were received in psychiatric clinics, of which 1/3 were diagnosed with "neurasthenia."

However, when he rediagnosed 100 patients with "neurasthenia" according to the U.S. diagnostic criteria for mental illness, he found that 93 cases could be diagnosed with "depression," of which 87 met the diagnostic criteria for "major depressive disorder."

Depression took over as "neurasthenia" and took the stage in China.

The term "depression" was originally an imported product, first proposed by the ancient Greek physician Hippocrates.

He once proposed the famous "humor theory", which is revered by the West as the "father of medicine". He believes that depression is caused by an imbalance in the blood, mucus, yellow bile, and black bile in the human body (too much black bile).

The melancholy English word melancholy, or melainachol from the Greek, originally means black bile. In the pre-Qin period of the mainland at the same time, depression was called "depression".

The Earliest Chinese medical classic, the Yellow Emperor's Inner Classic, records: "Anger hurts the liver, joy hurts the heart, thought hurts the spleen, sad lungs, fear hurts the kidneys." "The three pessimistic emotions of thinking, worrying, and fearing are the manifestations of depression.

The Renaissance was a "highlight moment" for depression. Leonardo da Vinci, Newton, Michelangelo, Darwin... Whether it is a big coffee in the literary and art world or a big cow in the scientific world, there are traces of being tortured by depression.

So much so that depression was once seen as an "aristocratic disease."

To the new human beings of the 21st century, I am emo, you lie flat, he nets the clouds... Young people seem to be starting to "get depressed for everyone.". Simply viewing depression as a mental illness is actually a misunderstanding.

According to biological explanations, neurotransmitters in the brain determine our emotional state, and neurotransmitters are also affected by genetic factors. Therefore, in general, depression is the result of a combination of genetic factors and social and family environment.

More than 350 million people worldwide suffer from depression. A who-published report shows that in the decade between 2005 and 2015, the number of people with depression increased by 18.4% globally. During the same period, the global population grew by 12.7%.

Due to The Large Population Base in China, the number of people with depression reached 54 million in 2016.

According to WHO's projections, depression will become the world's largest burden of disease in 2030. Around you and me, 1 in 10 people suffer from depression.

02

Antidepressants are currently one of the main means of treating depression.

The earliest drugs used to treat depression are not ideal and have large side effects, such as headaches, dizziness, rashes, etc., and sometimes react with food, drink, etc., resulting in high blood pressure. Often the efficacy has not yet come out, and the side effects come first.

Beginning in the 1980s, with the advent of selective serotonin reuptake inhibitors (SSRIs), these drugs quickly became the clinical choice due to their significant antidepressant effects and few side effects.

So far, antidepressants have been upgraded dozens of iterations.

In China's antidepressant market, imported drugs account for half of the country. Domestic pharmaceutical companies mainly produce generic drugs. Among them, Shandong Dongwei Pharmaceutical, Sichuan Kelun Pharmaceutical (002422. SZ), Shanghai Zhongxi Pharmaceutical, Jiangsu Enhua Pharmaceutical (002262. SZ) and other market share is at the top.

Jingwei Pharmaceutical and Kelun Pharmaceutical mainly produce generic drugs of escitalopram.

Jingwei Pharmaceutical is a "specialized and specialized" enterprise in Shandong Province, with a history of nearly 30 years. Due to a number of technical invention patents, Jingwei Pharmaceutical was also awarded the title of "China Patent Shandong Star Enterprise".

Kelun Pharmaceutical is an international level "single champion" enterprise. As early as 2011, Kelun Pharmaceutical stood out in the first batch of "National Technological Innovation Demonstration Enterprises" identified by the Ministry of Industry and Information Technology, becoming the only pharmaceutical enterprise in Sichuan Province to receive this honor at that time.

Kelun Pharmaceutical has a subsidiary called Shandong Kelun, which is a municipal specialized new "little giant" enterprise in Binzhou City in 2020.

In addition to escitalopram, Eli Lilly's original duloxetine is also a popular drug on the market. It not only treats major depressive disorder, but also compensates for the lack of other antidepressant drugs in the treatment of physical pain.

In 2007, duloxetine entered China. In its market share, Eli Lilly, Sino-Western Pharmaceutical and Enhua Pharmaceutical are "three points of the world".

Enhua Pharmaceutical is the only enterprise in China focusing on the market segment of central nervous system drugs, and the products developed by the company include narcotics, psychiatric and neurological drugs.

In September last year, an investor asked Whether Enhua Pharmaceutical was "specializing in special new" corporate standards. The secretary of the board of directors of Enhua Pharmaceutical said that the company's scale and qualification exceeded the nationally recognized "specialized and specialized" enterprise standards.

Specialization and specialization are specialization, refinement, specialization and novelty. Innovation is the main feature of novelty, and patents are the specific manifestations of innovation.

Take the manufacturers of antidepressants, the leaders of several subdivision tracks are more prominent in terms of patents.

In addition to the pharmaceutical companies mentioned above, Jingxin Pharmaceutical (002020. SZ) is the winner of the "China Patent Gold Award"; Kanghong Pharmaceutical (002773. SZ) won the "Outstanding Achievement Award for Innovative Drugs in China".

03

Churchill famously said, "Depression in my heart is like a black dog that bites me at every opportunity." ”

Unlike other diseases, although antidepressants have been working towards "reducing side effects and improving cure rates", depression is still difficult to cure.

Relevant data show that the medical treatment rate of depressed patients in China is 9.5%. Of the patient population presented, only 0.5 per cent were adequately treated.

The scarcity of experienced psychiatrists is one of the main reasons.

In 2017, there were only more than 20,000 psychiatrists practicing in China, which equates to 1.7 psychiatrists per 100,000 people, far below the world average of "4.2 psychiatrists per 100,000 people".

Not only that, the distribution of mental health resources on the mainland is uneven. Psychiatric clinics in first-tier cities are overcrowded, and many district and county hospitals do not have beds for mental illness.

Doctors have limited energy to allocate to depressed people, which also leads to more frustration in already depressed patients. "Make an appointment for 1 week, consult for 4 minutes, and the expert number of 50 yuan has not been exchanged for a word of concern." Some netizens wrote on Weibo.

Dissatisfaction with the consultation process and treatment results will also be transmitted to the medical staff of the psychiatric department.

Sina once did a survey, in a top three psychiatric hospital in Beijing, dozens of medical staff taking antidepressants, the total number of hospitals is only 200 people.

To some extent, psychological counselors have played the role of "saving the scene".

In 2002, the state opened the "Psychological Counselor Qualification Examination". However, due to the low threshold of the exam, as long as the sudden brush questions may pass the exam, many psychological counselors have even delayed the treatment of depressed patients because of the lack of professional level.

In 2017, the state canceled the psychological counselor qualification certificate examination.

In September 2020, the Health Commission issued the "Work Plan for Exploring Special Services for the Prevention and Treatment of Depression", and depression screening was included in the student health examination program and the routine pregnancy examination and postpartum visits of pregnant women.

The Health Commission has also set kPIs, requiring a 50% increase in depression visits and a 30% increase in treatment by 2022.

The small goal is already there, is it still far from defeating the "black dog"?