Rapid Response Therapies for Major Depression Could Dramatically Reduce Societal Cost

Major depressive disorder (MDD) persists as a significant health concern not merely for its debilitating individual impact but also its striking socioeconomic implications. Traditional methodologies for assessing the societal burden often do not account for several hidden-cost components, inadequately addressing the magnitude of the problem. To truly apprehend the societal toll of MDD, an integrated perspective is required—one that considers the disease prevalence, comprehensive cost implications, the effects of therapeutic interventions, and the rapidity of the response of the therapies.

Recent data indicate that, in 2019, nearly 8% of American adults, or approximately 19.8 million individuals, reported moderate to severe depressive symptoms with a PHQ score of 10 or greater and were diagnosed with MDD. (Implicit in this calculation is the possibly flawed assumption that those with mild depressive symptoms scoring less than 10 and a diagnosis of MDD do not contribute to the societal burden and do not have personal costs.)

Putting the economic impact into focus, MDD cost the American adult population a staggering $333.7 billion in 2019. Translated into 2023 figures, this constitutes a burden of approximately $382.4 billion. To further break down this cost per individual with MDD: Direct health care costs comprise 38.2% of the total, while indirect costs account for a more substantial 61.8%. Work-related indirect costs include presenteeism (13.0%), absenteeism (11.5%), unemployment (9.1%), all-cause mortality (2.9%), and disability (1.4%). Additionally, work-related costs for adults without MDD who live in a household with an MDD-affected individual contribute to 24.0% of the total cost. Therefore, almost two-thirds of the economic burden of MDD is attributed to indirect costs, underscoring the importance of understanding MDD’s comprehensive socioeconomic impact. At an individual level, the total cost per individual in 2019 was $16,854.

A rapid-response MDD therapy, with a two-week response rate of 50%—a considerable improvement over current treatments—could theoretically mitigate the economic strain of MDD by $26 billion in 2019 or a more significant $29 billion in 2023.

These estimations are more than merely speculative. Rapidly acting treatments—such as accelerated transcranial magnetic stimulation (aTMS), electroconvulsive therapy (ECT), Stanford Intelligent Accelerated Neuromodulation Therapy (SAINT), and Ketamine Infusion Therapy (KIT)—already exist.

If health care payers embrace these interventions and physicians can agree on prescription guidelines, these once theoretical numbers could become real, substantially alleviating the economic pressure exerted by MDD. The potential is immense, and the psychiatric community must unite to turn the possible into reality. ■

Richard A. Bermudes, M.D., is the founder of Mindful Health Solutions in San Francisco and a volunteer assistant clinical professor of psychiatry at the University of California, San Francisco. He is also the co-editor of Transcranial Magnetic Stimulation: Clinical Applications for Psychiatric Practice from APA Publishing. APA members may purchase the book at a discount.