Approximately 14.8 million American adults2 (6.7%

of the population) suffer from MDD, and cost employers more than $44 billion per year in lost productive time and 387 million days per year of disability.1 While the economic costs are substantial, the personal costs of prolonged suffering are incalculable. The costs of MDD are high, in part because it takes so long for patients with MDD to recover from the illness. Even after 1 year of treatment with enhanced resources under a structured algorithm, only 11% of patients achieved remission.3 This low recovery rate is not Inhibitors,research,lifescience,medical simply a matter of needing more or better medications. There are more than 20 treatments for MDD approved as effective by the Food and Drug Administration Inhibitors,research,lifescience,medical (FDA). The challenge is choosing the best treatment for each patient. The current treatment guidelines for MDD of the American Psychiatric Association4 support a “watchful waiting” approach to

determine if a particular medication will be useful for an individual patient. In order to determine Inhibitors,research,lifescience,medical whether a medication will lead to response (≥50% reduction in depressive symptoms) or remission (nearly complete resolution of symptoms), it is recommended that a physician wait to see if it will be effective,4 On average, at least 4 weeks are needed to attain response and 6 weeks to attain remission during treatment with an initial selective serotonin reuptake inhibitor (SSRI) antidepressant; in a number of cases, however, remission can take 12 weeks or longer to attain.5 In practice, physicians commonly wait 6 to 8 weeks to determine if a patient will recover with whichever medication

is chosen.6,7 It is not surprising Inhibitors,research,lifescience,medical that, under the current treatment paradigm, most patients face a long and frustrating course of treatment. The Sequenced Treatment BMS 777607 Alternatives to Relieve Depression Inhibitors,research,lifescience,medical (STAR*D) study, the largest study of MDD conducted in the United States, showed that even with enriched resources devoted to treatment, recovery with the first selected SSRI occurred only about 30% of the time.8 More than 20% of those who failed to improve with the first treatment simply stopped taking medication, Mephenoxalone primarily within the first 2 weeks.9 Although medication may take up to 12 weeks to be effective, 42% of patients discontinue medication within the first 30 days.10 A high proportion of the patients who prematurely stop treatment are from ethnic minority groups,10 and this may contribute to the significantly poorer clinical outcomes observed among ethnic minority patients.11 Failure to respond to treatment at any one step is commonly followed by “sequential treatment” in which a subsequent treatment is utilized either alone in combination,12-14 followed by another period of watchful waiting.