Depression may be neurotoxic

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-neurotoxic

References

  1. de Diego-Adeliño J et al. A short duration of untreated illness (DUI) improves response outcomes in first-depressive episodes. J Affect Disord. 2010;120(1-3):221-5.
  2. Furukawa TA et al. How many well vs. unwell days can you expect over 10 years, once you become depressed? Acta Psychiatr Scand. 2009;119(4):290-7.
  3. Ciudad A et al. Early response and remission as predictors of a good outcome of a major depressive episode at 12-month follow-up: a prospective, longitudinal, observational study. J Clin Psychiatry. 2012;73(2):185-91.
  4. Rush AJ et al. STAR*D: revising conventional wisdom. CNS Drugs. 2009;23(8):627-47.
  5. Millan MJ et al. Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nat Rev Drug Discov. 2012;11(2):141-68.
  6. Gorwood P et al. Toxic effects of depression on brain function: impairment of delayed recall and the cumulative length of depressive disorder in a large sample of depressed outpatients. Am J Psychiatry. 2008;165(6):731-9.
  7. Videbech P et al. Hippocampal volume and depression: a meta-analysis of MRI studies. Am J Psychiatry. 2004;161(11):1957-66.
  8. Stockmeier CA et al. Cellular changes in the postmortem hippocampus in major depression. Biol Psychiatry. 2004;56(9):640-50.
  9. Sheline YI, et al. Depression duration but not age predicts hippocampal volume loss in medically healthy women with recurrent major depression. J Neurosci. 1999;19(12):5034-43.
  10. Frodl TS, et al. Depression-related variation in brain morphology over 3 years: effects of stress? Arch Gen Psychiatry. 2008;65(10):1156-65.
  11. Kessing LV et al. Recurrence in affective disorder. I. Case register study. Br J Psychiatry. 1998;172:23‑8.
Country selection
We are registering that you are located in Brazil - if that's correct then please continue to Progress in Mind Brazil
You are leaving Progress in Mind
Le informazioni contenute nel nuovo sito prescelto possono non essere conformi al D.Ivo 219/06 che regola la pubblicità dei medicinali per uso umano e le opinioni espresse non riflettono necessariamente le posizioni dell’azienda, non sono da essa avvallate.
Accesso riservato a Operatori Sanitari
Per accedere si prega di registrarsi o, in caso sia già stato fatto, di autenticarsi
L’accesso a Progress in Mind Italia è consentito unicamente agli Operatori Sanitari (medici e farmacisti). I contenuti di questo sito sono prodotti da un team di Operatori Sanitari il cui obiettivo è presentare le ultime novità in ambito psichiatrico e neurologico, attraverso interviste, registrazioni audio/video di seminari con opinion leader, report e sintesi di congressi sia internazionali che nazionali. Per poter accedere al sito è quindi necessario registrarsi e fornire alcuni dati così da poter verificare che l‘utente sia un Operatore Sanitario.
Hello
Please confirm your email
We have just sent you an email, with a confirmation link.
Before you can gain full access - you need to confirm your email.
The information on this site is exclusively intented for health care professionals.
All the information included in the Website is related to products of the local market and, therefore, directed to health professionals legally authorized to prescribe or dispense medications with professional practice. The technical information of the drugs is provided merely informative, being the responsibility of the professionals authorized to prescribe drugs and decide, in each concrete case, the most appropriate treatment to the needs of the patient.
Congress
Register for access to Progress in Mind in your country