Core Insights - The current mainstream antidepressants face challenges such as slow onset, limited efficacy (40%-65%), insufficient long-term tolerability, and low patient adherence [1][2] - The domestic antidepressant market is still dominated by traditional SSRIs, but local innovative drug development is entering a harvest period, with micro-innovative drugs like Trospium and Venlafaxine showing promise [1] - Future development directions focus on precision treatment and personalized medication [1] Current Treatment Shortcomings - Depression is one of the most common mental disorders, characterized by persistent low mood, anhedonia, and decreased energy, with unclear etiology [1] - Existing first-line antidepressants like SSRIs have limited efficacy, with about one-third of patients not achieving relief after multiple treatment steps [1] - Current antidepressants have a slow onset, typically requiring 1-4 weeks for improvement and 4-8 weeks to reach treatment goals, posing risks of suicide during acute phases [1] - There is room for improvement in precision treatment for different subtypes and special populations, as well as addressing issues like patient-initiated drug discontinuation [1] Efficacy and Long-term Use - The efficacy of existing antidepressants ranges from 40% to 65%, with variations based on the heterogeneity of depression and specific patient characteristics [2] - Long-term use highlights the importance of safety and tolerability, with common adverse effects including gastrointestinal reactions, CNS effects, and sexual dysfunction [2] - Some drugs, like Escitalopram and Venlafaxine, have lower adverse event rates, while certain adverse effects may benefit specific patients [2] Domestic Market Overview - In 2024, the sales of antidepressants in China exceeded 8 billion yuan, with SSRIs accounting for 3.58 billion yuan (43.44%) of the market [3] - SNRIs and traditional Chinese medicine also hold significant market shares, with the top-selling antidepressants including Escitalopram and Agomelatine [3] - Generic drugs are expected to maintain a considerable market share due to price advantages, while innovative drugs will benefit patients through improved safety and efficacy [3] Development of Domestic Antidepressants - Currently, there is one approved innovative antidepressant in China, with over twenty in clinical trials, indicating a harvest period ahead [4] - The only marketed local innovative drug is Trospium (Ruxinlin), which is expected to see growth after entering the medical insurance system in 2025 [4] - Promising candidates in various stages of clinical trials include monoamine neurotransmitter antidepressants and NMDA antagonists [4]