[Residual symptoms after a treated major depressive disorder: a survey among private psychiatrists].
Recent studies suggest that depression with residual symptoms is a frequent progressive form of this disease. It is associated with a poor prognosis that translates into an earlier and higher relapse rate, and has a significant medical and social impact. Several literature reviews emphasize that residual symptoms are under-evaluated and that their treatment should follow an incisive strategy with the goal of complete eradication of symptoms. Specific patterns have not been detected either, and the evaluation of residual symptoms remains subject to numerous biases due to the lack of a validated definition. The purpose of this study was to analyze the opinions and attitudes of psychiatrists about residual symptoms following major depressive episodes treated with antidepressants as part of their daily private practice.


METHODS
867 psychiatrists were selected from across France to form a representative sample of the medical specialization. They were questioned with a closed-choice questionnaire on the scope of the residual depressive symptoms concept (definition, professional consensus), determining factors in their onset (factors associated with the patient, with the initial episode, with management) and their practical and therapeutic attitude towards these symptoms.


RESULTS
The estimated prevalence of residual symptoms in their depressed patients was 25%. Fifty-seven percent of the physicians queried felt the concept was appropriate, but 70.3% thought that it did not have a strong professional consensus. The definitions deemed most appropriate were those involving the persistence of clinical signs (asthenia or minor cognitive impairment), whereas the use of psychometric criteria was mentioned less often. There is a clear absence of consensus concerning the diagnostic delay of residual symptoms, as 30% diagnosed them after 6 months. Responses about factors that may be predictive or affect the onset of residual symptoms (associated with the patient, the nature of the initial episode and the management) did not reflect a unified position, nor did they necessarily correspond to the data in the literature. However, while the therapeutic attitude seemed adequate (verifying treatment compliance, clinical re-evaluation, therapeutic re-adjustment), 64% of the physicians considered residual symptoms to be a therapeutic challenge.


CONCLUSIONS
Through the wide disparity of responses, this observational study demonstrates the absence of consensus with regard to the concept of residual symptoms. While it does appear that practitioners often adopt an approach that is pragmatic yet still close to that recommended by the ANAES [Agence National d'Accréditation et d'Evaluation en Santé, French National Health Accreditation and Evaluation Agency], such an approach does not seem to be optimized for the specific treatment of these symptoms. This clinical concept remains little studied, and lacking a specific definition, appears to be under-evaluated and under-treated by conventional treatment strategies. Further research on residual symptoms is necessary in order to establish true and valid definitions that will.
Mouchabac
S
S
Département de psychiatrie et de psychologie médicale, Hôpital Saint-Antoine, 184, boulevard Saint-Antoine, 75571 Paris cedex 12.
Ferreri
M
M
Cabanac
F
F
Bitton
M
M
D000328:Adult; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology; D015995:Prevalence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires