Citalopram benefits society Depression is a severe disease that results in a massive loss of working days among young people (Murray & Lopez, 1996). Although not yet generally accepted, depression in the elderly is also a very common disease that impairs the quality of life of the sufferers. The most serious complication in depression is the risk of suicide. Around 60% of young people who commit suicide do so because of depression. In the elderly, the incidence of suicide is rising, and in the elderly, too, depression is often the reason for attempted suicide. In this age group, it is mainly men who take their own lives. Approximately 10 to 20 years ago, the selective serotonin reuptake inhibitors, also called SSRIs, were introduced in the treatment of depression. This treatment was a greater advance than was realised at the time. In the USA, consumption of antidepressants has increased threefold in the last 10 years, and this is due to the increased use of SSRIs. In Sweden, consumption of antidepressants quadrupled in the period 1991 to 1999. There, the most widely used preparation is citalopram, which is also the leading treatment in many other European countries. Citalopram is now marketed throughout Europe, including the former Eastern Bloc, in Canada, the USA and Australia, and in a large number of countries in Asia and Latin America. Also effective against anxiety The widespread use of SSRIs has revealed that they can be used to treat not only depression but also anxiety disorders such as panic disorder, social phobias, generalised anxiety, OCD (obsessional thoughts/compulsive acts), and what is for many women the very unpleasant premenstrual dysphoric disorder (PMDD). Unfortunately, the introduction of SSRIs has not given us more effective antidepressants. SSRIs are just as effective as the so-called tricyclic antidepressants, which have been in use for a long time. However, SSRIs have fewer side effects and are also very effective in the treatment of anxiety disorders. What is the reason for the widespread use of SSRIs? It is now apparend that depression is too rarely diagnosed and too rarely treated, and today more is being done to identify those patients who are suffering from depression and need treatment. Because SSRIs have fewer side effects, they can be used to treat patients with chronic depression over longer periods of time ­ in some cases, for the rest of the patients life. One thing is very important: with the new preparations having fewer side effects, we may now include elderly patients in the pharmacological treatment of depression. Dementia and depression 5% of all people over the age of 65 years suffer from dementia ­ a group of disorders that is very frequently accompanied by depression or anxiety symptoms. For example, 25% of patients suffering from Alzheimers dementia in fact meet the criteria for major depression. If less severe forms of depression are included, the percentage goes up to 50. When such symptoms as restlessness, anxiety, fear/panic and aggression are included, 85% of Alzheimer patients suffer from emotional disturbances. Controlled doubleblind studies have shown that citalopram has a favourable effect not only on depressive symptoms in dementia patients, but also on anxiety and other emotional disturbances (Nyth & Gottfries, 1990). This is extremely important because it is actually the emotional symptoms that cause suffering in dementia patients. The aim in the treatment of dementia patients should be not only to improve the patients memory ­ this may be achieved using acetylcholinesterase inhibitors ­ but also to alleviate the emotional symptoms. Cognitive (memory and learning) disturbances and depression are the most frequent reasons for referring patients to an institution. It is evident that treatment with citalopram is able to postpone the transfer of elderly patients to an institution. This is important for the patients and their families, as well as for society. Increased use in the elderly In Sweden, there has been a distinct change in the consumption of antidepressants in both men and women in the different age groups. Previously, they were used mainly by patients between 50 C. G. Gottfries Medical doctor, Lund Universitet, 1958 Ph.D., 1968 Professor of psychiatry and head physician at the Psychiatric Clinic, University of Umeå, 1971-77 Professor and head physician at St. Jörgens Hospital, Department of Psychiatry and Neurochemistry, Göteborg University, 1977-91 Secretary in WPAs biological section, 1976-81 Professor of geriatric neuropsychiatry, Göteborg University, Institute of Clinical Neuroscience, Department of Psychiatry and Neurochemistry, Sahlgrenska University Hospital / Mölndal, Sweden, 1992. Murray, C.J.L.; Lopez, A.D.: The global burden of disease: A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. 1996. Cambridge Harvard University Press. Nyth, A.L.; Gottfries, C.G.: The clinical efficacy in treatment of emotional disturbances in dementia disorders: a Nordic multicentre study. 1990. Br J Psychiatry 157:894-901. 26 Annual Report 1999 1999 was both an eventful and a successful year for H. Lundbeck A/S. The years biggest event was the Supervisory Board Arne V. Jensen (Chairman) Flemming Lindeløv Lars Bruhn (Vice-Chairman) Henrik He Board of Management Erik Sprunk-Jansen President & CEO Flemming Juul Jensen Executive Vice Pres Contents The basis of our activities Group financial highlights 1995-1999 Report 1999 An Essay on T Acalypha wilkesiana (East Indies). Copperleaf is a foliage plant that is related to the common Poins The basis of our activities The basis of our activities is the brain and its functions ­ and the dis Report 1999 Significant events in the financial year The substantial growth in recent years resultin Profit for the year (DKKm) 650 600 550 500 450 400 350 300 250 200 150 100 50 0 1995 1996 Profit for Profit before tax was DKK 926 million, while profit after tax and minority shareholders was DKK 616 Research and development costs (DKKm) 900 800 700 600 500 400 300 200 100 0 1995 1996 1997 1998 1999 Today, manufacturers of generic products are allowed to market and sell generic Cipramil® in a numbe Income from Celexa® (DKKm) 800 700 600 500 400 8% 300 200 100 0 1996 1997 1998 1999 6% 4% 2% 0 9% 18 Agaricus bisporus (Europe). The Portobello mushroom is an ordinary, brown garden mushroom that is gr expressions, their peculiar qualities. Memory can think of a name. But for recollection the name is Even in dreams, we seek meaning and coherence through the stories of the dream. There are dreams tha Oreocereus doelzianus (The Andes). The hairs protect the cactus against the cold and the strong morn It seems to me that more than memory and recollection it is the ethical impulse that makes the human A multitude of nuances in language speak of fundamental moods that derive from the brain. Mood, humo Fucus serratus. Serrated wrack. A form of brown alga. Common in Danish waters. 18 Readers who do not share Kierkegaards religious view of life can nevertheless not get away from Kier Research and Development thus strengthened our total development portfolio in 1999, partly through p Rebutia heliosa (Bolivia). A rather hardy, conical cactus that has adapted to great heights and a ha progress with the aim of uncovering new molecular mechanisms involved in the development of depressi Development portfolio Compound Almotriptan S-enantiomer Rasagiline TV 1203 Siramesine Gaboxadol Lu 3 Cipramil® prevents depression Lundbeck has carried out two studies of the prophylactic effect of Cip The patients were then randomised ­ in accordance with a code ­ for double-blind treatment with eith Citalopram benefits society Depression is a severe disease that results in a massive loss of working Alocasia odora (tropical Asia). Green foliage plant. Grown for its appearance. and 60 years of age, Fucus serratus. Serrated wrack. A form of brown alga. Common in Danish waters. Lundbeck on the worl Despite the growing use of antidepressants, the market will be affected in the years ahead by the ex In the 1960s, treatment of anxiety was revolutionised with the introduction of benzodiazepines, whic prove diagnosis of the disease. It is estimated that, within any given year, around 25% of patients Hibiscus (tropical plant). Better known in Denmark as the Hawaii flower. The beautiful stamens can b Lundbecks products Antidepressants Cipramil®/Seropram®/Cipram®/Celexa®/Sepram® (citalopram) Indicati Brassica oleracea. Better known as red cabbage. An edible cultivated plant that has been known since Growth in a good environment Lundbeck regards it as vital that fast growth and continuous improvemen Accounts Accounts Accounts Summary for the Group 1993-1999 Profit and loss account (DKKm) Net turnover Profit before research Ratios Net profit ratio (%) Return on assets (%) Return on equity (%) R&D costs as a percentage Comments on the accounts Accounting policies The Accounts have been prepared in accordance with Int In addition, Lundbeck expected a profit before tax above DKK 900 million, which is consistent with t Comments on the accounts Costs Lundbecks total costs, exclusive of financial items and tax, were DK DKK 7 million in 1999, against a net loss of DKK 2 million in 1998. Net currency income included in Comments on the accounts Cash flow Lundbecks cash flow from operating activities amounted to DKK 83 The Supervisory Board proposes distribution of a dividend of DKK 2.25 per share, or DKK 130 million. Comments on the accounts Incentive plans Three new incentive plans were introduced at Lundbeck in c The company has authorisation to grant 500,000 options. On 17 June 1999, the company purchased 500,0 Comments on the accounts Managing financial risks Lundbecks growing internationalisation through th Foreign currency risk Foreign currency exposure is a result of Lundbecks international activities. U Accounting policies General The annual accounts and the consolidated accounts have been prepared in Tax The parent company is jointly taxed with the two Danish and some of the foreign subsidiaries. Th Accounting policies Public loans and grants State development loans with a forgivable clause are re The net revaluation of shareholdings in subsidiaries is taken to the reserve for net revaluation acc Accounting policies Cash flow statement The consolidated cash flow statement is presented according Profit and loss account for the year ended 31 December 1999 Parent Company 1998 DKKm 2,095.5 702.5 Balance sheet at 31 December 1999 Assets Parent Company 1998 DKKm 15.7 25.7 41.4 503.8 168.6 113.7 Balance sheet at 31 December 1999 Liabilities Parent Company 1998 DKKm 110.0 205.9 1,457.3 45.0 1,8 Cash flow statement for the year ended 31 December 1999 Group 1999 DKKm 862.3 153.0 - 4.0 1,011.3 9 Signatures Copenhagen, 29 Februrary 2000 The Supervisory Board and the Board of Management have tod Notes 1. Net turnover Parent company 1998 DKKm 281.4 1,490.9 253.1 70.1 2,095.5 1999 DKKm 308.8 1,7 2. Staff costs - continued Incentive plans: In 1999, the company introduced a share option plan for Notes 3. Writedowns and provisions for Serdolect® Parent company 1998 DKKm 1999 DKKm The years writ 5. Audit fees Parent company 1998 DKKm 1999 DKKm Deloitte & Touche: Auditing services Non-auditi Notes 6. Financial items, net Parent company 1998 DKKm 49.3 5.1 43.7 12.8 110.9 18.9 8.4 23.9 4.8 2 7. Tax on the profit for the year Parent company 1998 DKKm 131.6 - 2.2 1999 DKKm 154.0 1.4 Current t Notes 8. Intangible and tangible fixed assets Group Product rights DKKm Purchase price at 1.1.1999 Land and buildings DKKm 687.8 1.8 - 0.8 194.7 5.3 878.2 171.9 0.2 43.5 4.2 211.4 666.8 Plant and ma Notes 9. Shares in subsidiaries Total DKKm Book value at 1.1.1999 Adjustment due to changed account 9. Shares in subsidiaries - continued Currency Nominal capital `000 200 1,000 200 400 5 60 500 5,000 Notes 10. Other shareholdings and other receivables Parent company Other shareholdings DKKm 9.6 94. 13. Capital and reserves Group Share capital DKKm Capital and reserves at 1.1.1998 Adjustment due to Notes 13. Capital and reserves - continued Parent company Share capital Share premium Reserve for n 14. Provisions for pensions and similar commitments Group The majority of the employees of the Group Notes 15. Provisions for deferred tax Group Temporary differences between calculations for accounti 15. Provisions for deferred tax - continued Parent company Temporary differences between statements Notes 16. Other provisions Group Share options for Group management and key employees DKKm Provisio 17. Long term debt Parent company 1998 DKKm 20.1 1999 DKKm 15.9 Mortgage debt due after five years 1 Notes 19. Contractual obligations Rental and leasing obligations Lundbeck has commitments amounting 20. Contingent liabilities Letters of intent The parent company has issued letters of intent to subs Notes 21. Financial derivatives Currency risk Net forward exchange contracts outstanding at 31 Dece 21. Financial derivatives - continued Interest rate risk The interest rate risk has been calculated Notes 22. Related party transactions Lundbeck defines related parties as: - The companys principal 24. Earnings per share (EPS) Earnings per share (EPS) is calculated as: (profit after tax and minori Shareholder Information Market value 1999 The allotment of shares in connection with the flotation Salvinia natans (tropical/subtropical plant) and Lemna (worldwide). Floating water ferns and duckwee Lundbeck worldwide For further information please see our homepage: www.lundbeck.com The UK Region Photos Thomas Grøndahl, Rigmor Mydtskov, et al. Design and production CreaVision A/S Reproduction No H. Lundbeck A/S 9 Ottiliavej DK-2500 Copenhagen - Valby Denmark Tel: +45 3630 1311 Fax: +45 3630 19