[Evolution of depressive disorders].
A MAJOR RISK RECURRENCE: The sparcity of data in the absence of treatment renders assessment of the natural course of depressive disorders difficult. Naturalist studies have identified various elements that characterise the evolution. After an episode of depression, usually lasting 6 to 8 months, the disorder is marked by a high risk of recurrence. Fifty to 85% of the patients having exhibited an episode of major depression will relapse at least once in their life. A CHRONIC DISEASE: The propensity in the repetition of depression and the socio-professional and family impact that results has led to an increasing number of authors to consider the problem as a chronic disease, like asthma or diabetes. IN TERMS OF MANAGEMENT: It is important to replace depression in the progressive perspective of a chronic disease and to avoid, after the first episode, the risk of relapses and recurrences. During treatment of the acute phase, we recommend treatment to be continued up to 12 months after complete remission, so as to reduce the risk of relapse. Regarding prevention of recurrences, treatment should be continued for more than 12 months in patients who have had 3 episodes of depression or, in certain cases, only two. THE CONSEQUENCES OF A LACK OF INFORMATION: Research work has shown that depressive disorders have been insufficiently treated: either the doses are too low or the prescription is withdrawn too quickly, or the patient does not fully comply. In the majority of cases, insufficient management stems from a lack of knowledge on the course of depressive disorders and on treatment modalities, as far as not only the practitioner but also the patient are concerned.
Spadone
Christian
C
Praticien hospitalier, Hôpital Saint-Louis (AP-HP), 1 av. Claude Vellefaux, 75010 Paris, France. christian.spadone@sls.ap-hop-paris.fr
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D006801:Humans; D012008:Recurrence; D012307:Risk Factors
D000928:Antidepressive Agents