China could quickly become the world’s largest antidepressant market, but hurdles remain

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You’re sitting there watching television, and it seems every other commercial is for a prescription medication — often one for depression. The antidepressant ads frequently feature a serious physician extolling the virtues of turning your life around with a daily pill.

That’s because the field is extraordinarily lucrative in the U.S. The antidepressant market was valued at $13.7 billion in 2018 and is expected to reach $15.9 billion by 2025, according to BrandEssence Market Research, an industry consultancy. By comparison, sales in China — with a population more than four times that of the U.S. — were estimated to be a mere $8.5 billion last year.

One reason this number is so low is that the Chinese do not face a bombardment of ads on TV and other media. In China, drug companies are only allowed to advertise in medical journals — effectively reaching only physicians.

Yet the Chinese are beginning to talk more about mental-health disorders, including depression. The opening-up has been “significant,” according to Fang Wang of the University of Surrey in England. This means that, while there hasn’t been an explosion in ads, there has been a blossoming of the conversation over these disorders.

Eli Lilly

Still image from a U.S. television commercial for the Eli Lilly prescription drug Cymbalta.

This is a big change from decades ago, when depression and related mental-health disorders were often marginalized or stigmatized in China. Yet “significant change in the Chinese discussion of depression and the use of antidepressants has taken place in the last ten years,” Fang and colleague Robert Geyer argue in the latest issue of China Quarterly, a peer-reviewed journal.

Yet China is developing so rapidly that it has been hard for regulators to keep up. This columnist visited a dozen pharmacies in the Chaoyang area of Beijing and found you could buy escitalopram — whose trade name, under Allergan PLC’s AGN, -0.05% manufacture, is Lexapro — over the counter in about half the stores. In a few, other antidepressants were available without a prescription. (Fluoxetine — marketed by Eli Lilly & Co. LLY, +2.19% as Prozac — was not available at any, though you can get it at most Beijing hospitals.)

But they are not widely consumed in China.

Numbers on Chinese pharmaceutical usage are notoriously hard to come by. But the little data we have suggest that, despite the evolution Wang mentioned, the disorder remains significantly underrecognized and undertreated. A World  Health Survey conducted in 2003 showed that only 1% of people with symptoms of depression had been treated in China. By comparison, 35% of Americans with depression were treated.

A more recent study has found that in urban primary-care settings in China, only 3% of elderly citizens with major depressive disorders received treatment by a mental-health-care provider. Less than 1% were treated with an antidepressant, the study found.

The shocking aspect is that these numbers are actual improvements. One can only imagine the droves of people who suffered in silence during the Cultural Revolution period, when China banished physicians to the countryside and employed poorly trained “barefoot doctors.”

China faces enormous public-health challenges. Its diabetes and obesity rates, for instance, are skyrocketing, and its population is aging at an alarming rate, which will put pressure on an already stressed system.

But mental disorders may be the quietest public-health problem in the country of 1.4 billion, with millions suffering needlessly. The government and public-health experts can foster the still-nascent opening-up that Wang mentioned by encouraging discussion and reducing the stigma surrounding depression.

Doctors, meanwhile, should increase routine screening of depression, anxiety and related mental-health disorders. Studies have shown that a health-care provider’s mere casual inquiry at an office visit can uncover emotional disorders that patients either didn’t know they had or were ashamed to talk about.

And Western drug companies will be more than happy to meet the demands of this enormous potential market.

Tanner Brown is a contributor to MarketWatch and Barron’s and producer of the Caixin-Sinica Business Brief podcast.