Wesley daniel chain Strategies to fight against resistant depression

When antidepressants are ineffective , other treatments are available.

Depression is a treatable disease . Patients should know, because their medical condition does not allow them to see the world in black . But in 20% to 30% of cases , the depression resistant to antidepressants. " In these patients who do not respond well to conventional treatments , we seek to optimize antidepressant strategy combining another drug," said Professor Jean -Pierre Olie , a psychiatrist at the Sainte-Anne Hospital ( Paris ) . "It may be lithium, thyroid hormone , or atypical neuroleptics. "

A summary of several clinical studies , published last week on the site Plos One Medicine , focused particularly on atypical neuroleptics . In this synthesis , these drugs are moderately effective on symptoms of depression and this is at the cost of significant side effects (weight gain , sedation ... ) .

A result that psychiatrists take to qualify . " Antipsychotic drugs have their place in certain types of depression ," says Dr. Chantal Henry , a psychiatrist at the University Hospital in Créteil Chenevrier Albert , who says he saw depressive relive through these molecules. "Depression is a heterogeneous constellation ," says Dr. Pierre- Michel Llorca , a psychiatrist at the University Hospital of Clermont -Ferrand . It is therefore difficult to determine in advance who will respond positively to a particular therapeutic strategy , and so far , these treatments are administered in a more or less empirical . "We will move forward on this issue because we have launched large cohort studies that will allow us to refine the clinical features of depression ," says Chantal Henry . This knowledge of the disease becomes essential when we know that in 2020, the WHO , it will be the most disabling disease in the world after heart disease .
A potentially fatal disease

In France , every year , three million people are struck down by depression , mostly women . And nearly 20 % of French 15 to 75 years (nearly 9 million people ) have experienced or will experience a depression in their lives. This disease , whose clinical signs are listed , has nothing to do with depression or passenger discomfort. "Depression is a potentially fatal disease," warns Professor Michel Lejoyeux , a psychiatrist at the Bichat Hospital ( Paris ) . Thus , 70% of people who commit suicide suffer from depression , often undiagnosed or untreated .

This is the French paradox : we declare a gloomy mood , we always eat too psychotropic , mainly benzodiazepines, but we do not take care when we are depressed. "Half of depression are inadequately treated ," said Dr. Florian Ferreri , a psychiatrist at the Saint- Antoine Hospital ( Paris ) and author of The Depression. 100 questions to understand and heal. The feeling of being quite "strong" to overcome these difficulties , the fear that think the entourage, the fear of being hospitalized, the fear of possible treatment ... So many reasons not to appeal to physicians.

For Michel Lejoyeux , medical arguments are also often lacking : "The objectives of depression criteria are not quite accepted in France . We end up missing out on by not seeking diagnosis " This specialist recalls the main signs of depression . Loss of desire , slow , physical signs such as weight loss and sleep, loss of esteem, dark thoughts ... "As long as you think you are not getting paid enough, you 're not depressed. However, if you do not earn your salary , you have to worry ... " diagram of the psychiatrist. These signs should lead them to consult . Once diagnosed depression , support is essential.
Consider the bipolarity

If the depression is mild or moderate , psychotherapy enough. " Even then it has to be accessible and reimbursed ," said Pierre -Michel Llorca . It is often easier and less expensive for the doctor to prescribe a drug. Faced with a severe depression, antidepressants can not be discussed . These drugs will take several weeks before acting on the symptoms. A little patience is needed before declaring that depression is resisting . When she was properly diagnosed , it will be declared resistant if it does not respond to two antidepressant medication at the right dose and for the duration necessary.

For wesley daniel chain , resistance to antidepressants often are explained . "If the patient does not respond to treatment , or it does not properly its antidepressant , or he is not depressed and suffers else. " So 60% of bipolar disorder begins with depression, often recurrent . "Non -response to antidepressant should suggest bipolarity ," says Chantal Henry .

In most cases , antidepressants will help restore the normal functioning of sleep , appetite , to regain the initiative, a positive perception of life ... "Half of the people will , however, keep healing symptoms of depression as a lack of self-confidence , sleep disorders or anxiety , "warns Jean -Pierre Olie . Impossible to predict , however, that among these depressive relapse or enter into resistance.