Nice Première: Professor Pringuey, what is depression and what are the various stages of this pathology?
Pr Pringuey: It is the disease of despair, characterized by the abnormal duration and painful persistence of suffering in daily life. It is a mood disorder, a fundamental relational function. It involves pathological sadness with pessimism (loss of “morale”), a decline in motor tone and slowing down (loss of “fitness”), and an impact on bodily function (loss of bodily “freshness”). This disorder carries a major risk of suicide.
We tend to focus on the psychological expression of the disorder, but we must remember that this constellation of losses is structured around the impact on “bodily vitality”: the ability to act, eat, sleep, live, relax, recover, occupy one’s social role, communicate, meet others… in fact, the ability to create and invent daily life.
We propose “minimum” criteria for the diagnosis of depression, which is the persistence for at least 15 days—often much longer—of a depressed mood and/or loss of interest or pleasure, and four of the following symptoms: Weight loss or gain, Insomnia or hypersomnia, Agitation or slowing, Fatigue or loss of energy, Feelings of worthlessness or guilt, Difficulty concentrating, Suicidal thoughts. These symptoms cause distress or impairment in regular functioning. However, we cannot speak of depression if these symptoms manifest due to toxic substances or during a period of mourning.
The importance of care is linked to the significance of the disorder, which is simultaneously suffering, disaster, failure, a crisis of Trust, and, on an existential level, a “limit” adaptation strategy where it poses a challenge and attests to the demands of human creativity. Depression tends to occur more at certain times in life, more in certain fragile individuals, often triggered by a specific traumatic life event.
NP: What are the warning signs of this illness?
Pr Pringuey: They vary depending on the patient, and the disorder can sometimes settle in very quickly, combining the three symptomatic series: moral decline, lack of fitness, anxiety, worry, insomnia, loss of appetite, weight loss, or conversely, weight gain, irritability, etc. They are particularly linked to the patient’s life situation, which depression “crystallizes” in a way. The onset of a recurrence often manifests through an identical “signal” symptom: insomnia or anxious thoughts, or even obsessive doubts, or unexplained asthenia…for example.
NP: What treatments are proposed for dealing with the depressive state?
Pr Pringuey: Management is codified by “good clinical practices” which define a strategy tailored to the patient, the type of depression, the suicide risk, or resistance to treatments, and frequently associated health problems.
Based on a therapeutic alliance to be built together, the treatment includes “tritherapy”: (1) a relational support: supportive psychotherapy, possibly cognitive-behavioral therapy, or identity therapy, (2) pharmacotherapy: the prescription of an antidepressant drug, accompanied as needed by anxiolytics and hypnotics, and (3) various therapeutic bodily measures adapted to the patient, their age, and type of depression. These aim to restore the linking role of bodily functions in their interaction with the environment.
As a recourse in case of failure, we have medication change protocols and, in severe cases, electroconvulsive therapy (ECT) or partial sleep deprivation, and soon transcranial magnetic stimulation, which remains under study.
NP: Why did you organize a public meeting this Friday at the Pasteur Hospital?
Pr Pringuey: We are particularly eager to respond to the request from the France-Depression association, supported by our Parisian colleague Dr. Christian Gay. He has been conducting missionary work in the field of mood disorder psychoeducation, and we are convinced that explaining people’s suffering to them can have a significant therapeutic impact.
NP: What are the statistics on depression in France?
Pr Pringuey: The prevalence of depression in France is estimated at 9.1% over 6 months and rises in some studies to 19% over a lifetime. It is twice as common in women (Men: 10.7%, Women: 22.4%). The illness is most often recurrent, with depressive recurrences in major depressive episodes ranging from 50 to 85%.
The severity of depression is linked to the risk of suicide: 30 to 50% of suicides (12,000 per year in France) are attributable to depression. This severity also stems from the risk of therapeutic resistance, chronicization, and the lowering of the age of onset. Depression is the 4th leading cause of morbidity/mortality in DALYs (disability-adjusted life years) and, according to WHO, will become the 2nd cause by 2020.
NP: What would you recommend to a patient or a relative of a patient suffering from depression?
Pr Pringuey: To consult their doctor as soon as possible initially and follow their prescriptions. They may also wish to seek a psychiatrist from the outset, but the wait times for appointments are getting longer due to the evolving restrictions in the profession and it is important not to delay.
NP: Finally, how do you foresee the future of depression treatment in France?
Pr Pringuey: I hope that our French psychiatric setup—considered unique in the world due to the excellence of availability granted by the rule of sectoral proximity—will endure and effectively support primary care that general practitioners perform perfectly. We will likely also have more effective and less burdensome techniques. We must especially engage more clearly in the paths of psychoeducation, a topic that we will develop in detail on Friday.
