Prospect of Anti-Depressives in China     
    
Melancholia has for some time been universally regarded by the medical circle to be a common mental disease. According to the most conservative estimates, China has a total of 26.0 million melancholia sufferers. As China's diagnostic technology is not as mature as western countries, and common people lack awareness of this disease, people seldom go to hospitals for therapy even if they think they may have the disease. Only around 10% of melancholia victims in China see doctors today. Researchers of clinical medicine in China started to pay real attention to treating melancholia in the early 1990s. The development of the anti-depressive market in China has been very slow. According to statistics of the pharmaceutical trading administrative department, the market volume of anti-depressives in China was only between RMB1.0 billion and RMB1.2 billion in 2001. Eight years later, the volume today is still less than RMB5.0 billion - negligible compared with the sales value of fluoxetine in the United States. The incidence of melancholia in Chinese nationals is however no lower than the incidence in other countries of the world. There is therefore still vast opportunity in the anti-depressive market in China.

Fluoxetine:
Domestic products can hardly compete with Prozac

Fluoxetine was put on market in 1986 and entered the Chinese market in 1995 (the trade name being Prozac). It was the first product of serotonin re-absorption depressives. The sales volume of fluoxetine fell rapidly after 2000.
  China promised the U.S. that the imitation drugs produced in Chinese enterprises were only allowed to be sold in China and could not be exported to overseas markets. Five pharmaceutical enterprises in China were approved in 1996 to produce fluoxetine active ingredient and formulations. As a matter of fact, however, fluoxetine produced in these Chinese enterprises holds only an extremely small market share. Their combined sales value of fluoxetine is less than 1/4 of the sales value achieved by Lilly of the United States in the Chinese market. The main reason is that in the past decade Lilly has done a lot of academic and marketing promotion work to doctors-in-charge in large and medium hospitals in China, so doctors are already very familiar with the advantages of Lilly's Prozac. Fluoxetine produced by domestic pharmaceutical enterprises can therefore hardly compete with Prozac.
   As fluoxetine has definite curing effect on melancholia and great quantities of low-price imitation products will be put in market, it is expected that fluoxetine will still have a huge space for development in the Chinese market. Nowadays, the compared sales value of Prozac and domestically made fluoxetine was around RMB1.2-1.5 billion per year in China.

Paroxetine:
The sales volume has increased

Paroxetine is also a serotonin re-absorption anti-depressive. It takes effect more quickly than fluoxetine. Paroxetine entered the Chinese market in 1999 (the trade name being Seroxat). As the price of imported Seroxat was quite high (as high as RMB25 per tablet in 1999), its sales volume in the Chinese market has been small. (Paroxetine is not yet included in the Drug Catalogue for National Essential Health Insurance, Employment Injury Insurance and Birth Insurance in China, which means that patients have to pay for this drug themselves.)
   With the expiry of the patent for paroxetine in 2008, many imitation varieties appeared in various countries of the world. The selling price of Seroxat in the Chinese market has therefore been reduced. The selling price has dropped to around RMB10 per tablet today. As paroxetine has fewer side effects and quicker curing effectiveness than fluoxetine, its sales volume in the Chinese market went up. It is hoped to replace the position of Prozac in the anti-depressive market in China. Reportedly, the sales value of paroxetine in the Chinese market was less than RMB1.0 billion in 2009.

Citalopram:
It is very suitable to Chinese patients  

Clinical tests prove that citalopram can relieve both melancholia and anxiety neurosis at the same time. Doctors report that most Chinese melancholia patients have symptoms of anxiety neurosis. Citalopram is therefore very suitable for use in the therapy of melancholia patients in China.
   Citalopram entered the Chinese market in 1999 (the trade name being Cipramil). It is unfortunate for Chinese patients that citalopram carries a premium price here and faces difficult market expansion. (The selling price of imported citalopram was once over RMB20 per tablet in 1999. The price was hardly acceptable to most melancholia patients, only having wages and salary to pay.) There is some relief, market-wise, in citalopram hydrobromide tablets produced by XiAn-Janssen Pharmaceutical Ltd. by renovating the structure of citalopram, since their selling price has been reduced sharply to only RMB8.1 per tablet. The key problem is that citalopram entered the Chinese market rather late. It will therefore take some time for citalopram to replace Prozac in the anti-depressive market in China. According to government estimates, the sales value of citalopram in the Chinese market was RMB500 million - 600 million in 2009.

Venlafaxine:
Hoped to rise to first place

Venlafaxine hydrochloride is a new anti-depressive developed and put in market by Wyeth of the United States in 1994. It entered the Chinese market in 2002. Imitation products including Nolexin capsule produced by Chengdu Darsina Pharmaceutical Co., Ltd have already been put on the market in China. According to statistics, the share held by venlafaxine in the anti-depressive market in China had already reached around 20% in 2008, and there is an evident trend of further growth. Due to factors such as high price, however, the sales value of venlafaxine in the Chinese market was still less than RMB1.0 billion in 2009. Nevertheless, there is a trend of rapid growth.
  Moreover, as health insurance is not yet available to all people in China, some anti-depressives with brisk sales in the international market such as sertraline, fluvoxamine and duloxetine can hardly be sold in the Chinese market today due to their high prices.