Professor Philip Gorwood, of the University Paris Descartes, Hospital Sainte-Anne, presented a Lundbeck Institute seminar on the neurotoxicity of depressive episodes . Neurotoxicity is clinically and therapeutically relevant. We should treat depression faster, better and longer.
To improve the long-term prognosis of a major depressive episode, we should:
- treat faster - reduce the duration of untreated illness
- treat better - focus on the quality of remission, do not tolerate partial response
- treat longer - prevent relapse and recurrence
Better response is achieved with shorter duration of untreated depression - so early treatment is important.1 The duration of depression before recovery may predict the amount of time the patient will be symptom free over the next 10 years.2
Don’t wait and see - lost chances
The ‘wait and see’ approach does not benefit patients. Delayed treatment may hamper full recovery that means a lot to patients,3 who want to feel as ‘good’ as they were before.
The STAR*D study used a series of trials over up to four treatment steps to define the tolerability and effectiveness of various options.4 Remission rates decreased in each step - and so we need effective first-line treatment.
Depression is associated with several cognitive deficits including impaired executive function, memory and processing speed.5 Even in remission, capacity for delayed recall declines steadily with the number of previous depressive episodes.6
Neurotoxicity is clinically relevant. Depressed patients have a smaller hippocampus than controls, and this may be due to repeated periods of MDD.7,8,9 Grey matter density in the hippocampus of MDD patients is declined.10
An old study, but the best of its type, looked at 22 years of data on the nation of Denmark to understand the rate of depression recurrence.11 The rate increased with the number of previous episodes - highlighting that depression is progressive. We need to prevent relapse and recurrence.
Partial remission is the enemy - tell your patients
Don’t let your patients stop treatment if they have not reached full remission. Stopping early reduces the chances of full recovery.
Share this information with patients. Armed with a better understanding of the importance of treatment for long-term recovery, they will have the incentive to make their own decision to commit to treatment.
For further detail on this topic please go to the feature on Lundbeck Institute Campus http://institute.progress.im/en/content/depression-may-be-neurotoxi
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
