A Key Opinion Leader Survey of Major Depressive Disorder (MDD) with Anhedonia in Canada on Frequency, Management, and Burden of MDD With Prominent Anhedonia

OBJECTIVES: Major Depressive Disorder (MDD) is a debilitating illness, with many patients exhibiting anhedonia (or loss of interest and pleasure) as a core symptom. To better understand its impact, a survey was conducted to gather Canadian healthcare providers’ (HCPs) insights on the prevalence, clinical features, diagnosis, burden, treatment, and unmet needs of MDD with anhedonia.
METHODS: Conducted between March and July 2024, this survey included 45 HCPs across Canada, who were interviewed by phone or virtually. The survey was approved by an independent institutional review board.
RESULTS: Most HCPs (93%) surveyed were psychiatrists and 80% reported challenges in diagnosing MDD with anhedonia. Among MDD patients with anhedonia, 44% experience prominent anhedonia (PA), which is recognized as a burdensome symptom. Escitalopram is the preferred first-line treatment for MDD patients with PA. Aripiprazole, bupropion, and brexpiprazole were identified as adjunct treatments; however, no clear consensus emerged on the best option for patients. Fifty four percent of MDD patients with PA are primarily covered by public insurance. One third reported that insurance coverage was occasionally a treatment barrier. Remission, defined as few to no MDD symptoms, typically requires more than 2 lines of treatment, and 52% indicated that relapse commonly occurs after remission. Over 70% stated MDD with PA severely impacts quality of life and workplace productivity. Approximately 41% of patients are employed and on disability. Half of MDD patients with PA exhibit suicidal thoughts/behaviors, and 22% require psychiatric hospitalization. At present, the greatest unmet need for both HCPs and MDD patients with anhedonia is the extensive expertise required to manage this complex condition and the difficulties in accessing treatments that address patients' specific needs.
CONCLUSIONS: Managing MDD with anhedonia is complex and requires a tailored approach, which is currently hindered with no available anhedonia-specific MDD treatments and guidelines.