Economics of depression and cost-benefit comparisons of selective serotonin reuptake inhibitors and tricyclic antidepressants


  • Dr. Lewis L. Judd M.D.,

    Corresponding author
    1. Department of Psychiatry, University of California, San Diego
    • Mary Gilman Marston Professor and Chair, Department of Psychiatry, University of California-San Diego, 9500 Dilman Drive, La Jolla, CA 92093
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  • Mark H. Rapaport M.D.

    1. Department of Psychiatry, University of California, San Diego
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The social and economic impact of depression on society at large has only recently been elucidated. The U.S. National Institute of Mental Health (NIMH) Epidemiology Catchment Area (ECA) Program demonstrated that the 1 year prevalence of DSM-III mood disorders was almost 10% in the adult population of the United States—or that in any year over 17 million adults suffer from a major mood disorder. Moreover, data gathered by the Cross-National Collaborative Group suggest further that the incidence of depression is increasing, not only in the United States, but in many countries all over the world. And results from the Medical Outcomes Study, which assessed the level of disability associated with depression compared with other common medical disorders, suggested that patients with major depression and dysthymia suffer greater levels of impairment than patients with hypertension, diabetes, arthritis, lung disease, and GI disorders.

A number of recent investigations have sought to quantify the costs of depression in the United States and the United Kingdom, and found that depression has remarkably high direct and indirect economic costs, comparable to those associated with other major public health problems. This paper reviews depression within this larger framework and evaluates the impact of treatment advances on the costs of depression. Both pharmaceutical-sponsored and non-sponsored cost-benefit analyses reveal that while the classical anti-depressants cost less on a per-pill basis, ultimately treatment may be less expensive with the newer SSRIs because of improved compliance leading to better outcomes. Depression 2:173–177 (1994/1995). © 1995 Wiley-Liss, Inc.