26 Disease landscape Depression Cognitive symptoms and the vicious cycle The negative effects of cognitive symptoms can deepen depression, preventing patients from emerging from their illness and returning to everyday life. B ecause of its widespread nature, there is a common wisdom around depression. Globally, over 300 million people are affected by the disease1 and many people know someone who has struggled with it, such as a friend or family member. The common wisdom includes the notion of the vicious cycle the idea that the patient struggles to come out of depression because his or her low mood leads to the inability to accomplish tasks, which leads to a low self-esteem, which continues to lower the mood and the cycle keeps spinning. Overlooked cognitive symptoms However, this common wisdom around the vicious cycle leaves out one very important component cognitive symptoms. Cognitive symptoms are often overlooked by both patients and physicians, and include symptoms such as low concentration and attention, forgetfulness and difficulty with words. Cognitive symptoms can lead to a loss of patients ability to function at home and at work, and this can create problems that contribute to a low mood and low selfesteem, perpetuating the vicious cycle. Recent market research by Lundbeck took a closer look at how physicians and patients view cognitive symptoms of depression and how the symptoms affect patients lives.2 DEPRESSION I cannot concentrate. I always got the data wrong. I made various small mistakes at the beginning...until I made a huge one. I felt useless. Wen, 45, head of planning, CN The research reveals a relatively low recognition amongst physicians of cognitive symptoms when treating depression, even though they see cognitive symptoms as a risk factor for relapse. These and other such findings suggest that reducing cognitive symptoms could be one important way to help patients living with depression to function better in their daily lives. Diagnosis vs treatment One quantitative study, which surveyed 1,096 physicians across nine countries, showed that one third of depression patients present primarily with a cognitive symptom. It also showed that 20-40% of depressed patients are estimated to have cognitive symptoms. Despite this, cognitive symptoms do not feature prominently in the reasons physicians decide to treat depression. The top three reasons to treat are suicidal thoughts, low mood and loss of interest or pleasure. At the same time, two thirds of physicians elect to treat all symptoms generally, without prioritizing cognitive symptoms. The persistence of negativity During treatment, physicians report the most frequently mentioned cognitive symptom is lack of concentration. They also report that lack of concentration and the inability to These days I avoid making commitments that will take up a lot of my time, or are out of my control. Because I dont know how Ill be that day, whether Ill have energy. Alexandre, 34, sales consultant, BR Other people had to pick up her [the patients] slack. Its annoying but it was too much of a hassle to get her to do it. She would say yes, but then not do it. It was often quicker just to do it yourself than having to constantly remind her and get all the negative interaction. I felt bad for her, but we all felt it was a relief when she went on sick leave. Lisa, co-worker, public health institution, CA Shell shout at me, I lost my key! And Ill always have to say, Calm down! Lets go look for it. First, lets look in your purse. 99% of the time, the key is in her purse. But her irritability with us is instantaneous, it just explodes because she cant have a logical thought. Lúcio, Saras husband, BR Magazine 2018 / 2019 P. 30 Try to treat Parkinsons like an old friend Patient story P. 6 P. 26 P. 38 FROM IDEA TO PATIENT COGNITIVE SYMPTOMS AND THE VICIOUS CYCLE LUNDBECK AND THE FASCINATING BRAIN 2 Contents 26 Contents Cognitive symptoms and the vicious cycle 28 Our patient footprint 16 The severity disconnect 18 Taking action to promote sustainability 4 Preface 6 From idea to patient 8 Mr Alzheimer is waiting in the street The sicker Enric Álvarez Guayta gets, the healthier Lundbeck Magazine 2018 / 2019 30 3 36 The off-time treatment challenge 38 Try to treat Parkinsons like an old friend Lundbeck and the fascinating brain As an 80-year-old with Parkinsons, how do you coax the best quality of life from your daily existence? A lifetime of experience and zest for 4 Preface This is Lundbeck Today, millions of people all over the world live with depression, schizophrenia, Alzheimers and Parkinsons diseases. At Lundbeck, we want to understand why these diseases occur and to develop the best treatments to help ease the symptoms or cure them completely. R ese Lundbeck Magazine 2018 / 2019 When most organs in our body get sick, we find compassion and care in people around us. But when our brain suffers, the world typically turns away. As a global specialist, we owe it to those who live with psychiatric and neurological disorders to fight stigma and promo 6 From idea to patient From idea to patient RESEARCH In Research, we identify new disease targets and establish and confirm an understanding of the mechanism of action for new, safe drug candidates. Researching new treatments requires deep insight into the disease and into the unmet medical needs Lundbeck Magazine 2018 / 2019 7 Developing innovative and safe treatments is complex. It takes approximately 10-15 years for a new drug to move through the pharmaceutical value chain from when an idea is conceived until an approved treatment is made available to patients. SALES In Sales, we infor 8 Patient story Alzheimers disease Mr Alzheimer is waiting in the street The sicker Enric Álvarez Guayta gets, the healthier he feels. To him, Alzheimers is primarily a menacing figure who lies in wait down on the street. But to his wife, Mònica Pàmies Bermúdez, Alzheimers moved in long ago. Lundbeck Magazine 2018 / 2019 9 10 Patient story Alzheimers disease Today, several years after Enric was diagnosed, Mònica is a seasoned observer of how Alzheimers is changing her husband. Enric himself doesnt think that theres anything wrong. No problem here! he says, flashing his wife a bright smile. W hen Mònica feels read Lundbeck Magazine 2018 / 2019 11 Enric had forgotten that Raquel didnt care for potatoes. When he protested against making food, it was because he couldnt find his way around his own kitchen. during the evening, when Mònica came home from work, theyd get bogged down in arguments that left her mor Lundbeck Magazine 2018 / 2019 Enrics sentences flutter with fragments of sense. Yet theres one particular place, Mònica says, where he is able to express himself fully. He goes to an art therapy class once a week. the morning until about midnight, when she goes to bed, she is attending to the acut 14 Patient story Alzheimers disease ENRIC ÁLVAREZ GUAYTA Customs broker Age 63 Residence Barcelona, Spain Diagnosis In 2014, Enric was diagnosed with Alzheimers disease. Children One son from a previous marriage Employment Enric worked as a customs broker until 2012, when he lost his job in a ro Lundbeck Magazine 2018 / 2019 15 MÒNICA PÀMIES BERMÚDEZ, ENRICS WIFE Freight forwarder Age 49 Residence Barcelona, Spain Children One daughter, Raquel, from a previous marriage, and one grandchild Employment Mònica works as a freight forwarder for an air- and sea-freight company. Everyday life Mòn 16 Disease landscape Alzheimers disease The severity disconnect The perception of Alzheimers symptoms can vary greatly between patients, their caregivers and their physicians. Recent Lundbeck research reveals that no matter how severe the Alzheimers diagnosis, the burden of the disease often fall Lundbeck Magazine 2018 / 2019 17 Caregivers status Patients underestimate their reliance Non-professional caregivers are often a spouse, son, daughter or another family member. More than one third of caregivers do not work. That could mean that for many caregivers, looking after their loved one 18 Taking action to promote sustainability Taking action to promote sustainability Since world leaders in 2015 adopted the 2030 Agenda for Sustainable Development, Lundbeck has acknowledged its responsibility in terms of the 17 Sustainable Development Goals (SDG), and six of them in particular.1 Lundbeck Magazine 2018 / 2019 19 LUNDBECKS APPROACH AND SAMPLED ACTIONS SDGs supported by Lundbeck GOOD HEALTH AND WELL-BEING GENDER EQUALITY DECENT WORK AND ECONOMIC GROWTH We address the global medical unmet need through the development, production and marketing of effective treatments. We 20 Patient story Depression A small caterpillar taking cover under a leaf The stigmatization of people with depression infiltrates schools and workplaces. It splits families apart. And its not only the acutely depressed who have to fear rejection; the high-functioning hide their mental health his Lundbeck Magazine 2018 / 2019 21 22 Patient story Depression Ruth has always suffered from sleep disturbances, and when after six months her boy finally slept through the night, she was no longer the same. Lundbeck Magazine 2018 / 2019 23 Depression entered Ruths own life back when she was a stay-at-home mother with two small boys. She was living what she describes today as a dream life and yet she felt ashamed. She felt ashamed that she wasnt happy. R uth has a demanding corporate job. She is re 24 Patient story Depression slipped under the covers. Moms taking a nap! I used to say. Ruth shudders at the memory. It sounds so weird to me now. In sleep, she could disappear. Outside the bedroom lurked a world she could not inhabit. She didnt have any strong feelings other than a hyperirrita Lundbeck Magazine 2018 / 2019 25 RUTH JOSEPH Accountant and a paralegal Age 52 Residence Dallas, Texas, USA Diagnosis Ruth was diagnosed with major depressive disorder around the year 2000. Her symptom profile includes anxiety. Her family has a marked genetic predisposition to mental illness. Rut 26 Disease landscape Depression Cognitive symptoms and the vicious cycle The negative effects of cognitive symptoms can deepen depression, preventing patients from emerging from their illness and returning to everyday life. B ecause of its widespread nature, there is a common wisdom around depr Lundbeck Magazine 2018 / 2019 accomplish tasks have the greatest impact on patients ability to function at work. And still only one-third of patients are prescribed cognitive behavioral therapy in addition to pharmacological treatment. Half of patients do not receive any cognitive support. Physici 28 Our patient footprint Our patient footprint Since the 1940s, we have been fascinated with neuroscience research, and our development and distribution of pioneering compounds continues to make a difference to patients worldwide. We are recognized for having reached millions of people living with Lundbeck Magazine 2018 / 2019 29 Our commitment At Lundbeck, we are committed to continuing to improve the lives of people living with psychiatric and neurological disorders. DEPRESSION 300 2002 Escitalopram was launched in 2002 and made available in about 100 countries worldwide, growing to a 30 Patient story Parkinsons disease Lundbeck Magazine 2018 / 2019 31 Try to treat Parkinsons like an old friend As an 80-year-old with Parkinsons, how do you coax the best quality of life from your daily existence? A lifetime of experience and zest for life is showing Sheng Kanghua how. 32 Patient story Parkinsons disease SHENG KANGHUA Engineer Age 80 Residence Beijing, China Diagnosis Diagnosed with Parkinsons disease in 2008, Sheng Kanghuas symptoms include tremors, muscle stiffness, memory impairment, poor sleep, dizziness and dystonia, which in his case involves sudden, int Lundbeck Magazine 2018 / 2019 33 Sheng Kanghua was 71 when he received his diagnosis, and hed never had any serious health issues before. A faint trembling in his right hand was the only visible sign that the connection between his brain and his body was deteriorating. I t is now nine years sinc 34 Patient story Parkinsons disease Everything will be different if you treat Parkinsons like an old friend, rather than an enemy. Like a friend During the course of a long life, Sheng Kanghua had to confront many hardships, and he discovered he was a man who strove to get more out of life than Lundbeck Magazine 2018 / 2019 35 It doesnt pain Sheng Kanghua to accept assistance from his family either. On the contrary. After a long life of being self-reliant, he has discovered that being open to help is enriching his old age. enemy, you will allow hatred into your mind and hurt yourself. I 36 Disease landscape Parkinsons disease PARKINSONS DISEASE P arkinsons is the second most common age-related neurodegenerative disorder after Alzheimers disease. An estimated six million1 people worldwide have Parkinsons. Classic symptoms of the disease include muscle rigidity, tremor, slowness Lundbeck Magazine 2018 / 2019 37 Motor symptoms physicians are trying to treat Tremor at rest Bradykinesia Rigidity Shuffling walk 27% Freezing of gait 24% Falling/imbalance 23% Lack og arm swing 19% Tremor on action 18% Lack of facial expression 17% Micrographia 15% Stoop 9% Pain (Parkinsons rela 38 Lundbeck and the fascinating brain C ognitive and knowledge-based analytics At Lundbeck, we are always looking for ways to accelerate the development of innovative medicines to treat psychiatric and neurological disorders. Thus in 2017, we entered into partnership with IBM Watson Health in or Lundbeck Magazine 2018 / 2019 39 Lundbeck and the fascinating brain Essential to Lundbecks efforts within psychiatric and neurological disorders is to maintain strong internal research and development capabilities in order to establish optimal networks and partnerships. We continue to build extern 40 Lundbeck and the fascinating brain G ene-modified mice In 2017, researchers at Lundbeck made breakthrough discoveries giving hope for new treatments of schizophrenia. We have identified several mechanisms in the brain which are not targeted by current treatments, but show that they are part o A Lundbeck Magazine 2018 / 2019 41 ntibody fragments from llamas Adding to our early research efforts at Lundbeck, we announced in 2017 a new cooperation with Belgian biotech company Confo Therapeutics, providing us with access to their very special technology platform. This platform is based on 42 Patient story Schizophrenia The eyes follow her, unblinking For a fearful child, a vivid fantasy world can be a refuge. It was for Ditte Grauen Larsen, whos now 26. But it also opened a door to a universe where eyes on the leaves of trees were watching her, and where reality was as slippery as Lundbeck Magazine 2018 / 2019 43 44 Patient story Schizophrenia S omeone who mumbles to themselves on the bus drunk, perhaps? Perhaps crazy? Anyone can spot a person like that from far away, says Ditte, and would quickly avert their gaze and sit somewhere else. Back in her schooldays, Ditte often felt that her classmates saw h Lundbeck Magazine 2018 / 2019 45 are sitting in back, the losers in front. Teenage Ditte has seated herself in the first row of the back half, in the hope that shell be teased less than up front. The bus is jam-packed with rowdy students, shrieking with laughter. Are they making fun of her? Shes s 46 Patient story Schizophrenia A turning point The eyes did not blink, and they followed her, depending on where she was. Ditte had the sense that they wanted to make sure that she executed her compulsive actions correctly. The eyes were real. They were just as real as trees and as the leaves on Lundbeck Magazine 2018 / 2019 47 DITTE GRAUEN LARSEN Schoolteacher Age 26 Diagnosis Ditte was diagnosed with paranoid schizophrenia in 2012. She has not taken any medications to treat mental illness for a couple of years now, and she is no longer being followed by the mental health system. In conn 48 Disease landscape Schizophrenia T SCHIZOPHRENIA he World Health Organization estimates that schizophrenia affects more than 21 million people worldwide. The disease is characterized by episodes of psychosis (losing touch with reality) in between periods of blunted emotions and withdrawal. Th Lundbeck Magazine 2018 / 2019 The main reasons for non-adherence, the physicians believe, are side effects and anosognosia, which is lack of patient awareness of the disease. Anosognosia can take several forms. It could mean that the patient doesnt believe they have the disease. It could also mean 50 The brain foundation The brain foundation Seventy percent of Lundbeck is owned by the Lundbeck Foundation. What does the Foundation do and what does it mean for Lundbeck, its patients and neuroscience at large? B ack in 1954, Grete Lundbeck, the widow of Lundbecks founder Hans Lundbeck, estab Lundbeck Magazine 2018 / 2019 51 INVESTMENTS IN NEUROSCIENCE The CEO of the Lundbeck Foundation, Lene Skole says, We are an industrial foundation, which means we are a combination of a business and a charity. We do not have owners, and income from our commercial activities usually dividends from 52 The brain foundation Committed to the brain Lundbeck and the Lundbeck Foundation share more than just the name and dividends. They also share the commitment to neuroscience: We want to be known as the brain foundation and we want Denmark to become one of the strongest brain research nations in Lundbeck Magazine 2018 / 2019 he says. The foundation model is unique and an immense benefit to Danish companies and the Danish economy. All successful companies are obvious targets for major international groups and they will be bought up if they dont have an owner that protects them. Being owned 54 Lundbeck in brief Lundbeck in brief We are focused, passionate and responsible in everything that we do, and we work determinedly to meet patients needs for those living with depression, schizophrenia, Parkinsons disease and Alzheimers disease. Our 5,000 skilled employees in more than 50 countr Lundbeck Magazine 2018 / 2019 55 Lundbeck is a specialized pharmaceutical company engaged in developing innovative treatments for people living with psychiatric and neurological disorders. Patients' needs Principles More than 370 million people worldwide are living with depression, schizophreni 56 Patient story Schizophrenia Parkinsons will be with you for the rest of your life. So its important to think about how you want to deal with it. If you see it as your enemy, you will allow hatred into your mind and hurt yourself. Instead, try to treat Parkinsons as you would a friend. Sheng Ka