Clinical guidelines for the management of treatment-resistant depression: French recommendations from experts, the French Association for Biological Psychiatry and Neuropsychopharmacology and the fondation FondaMental.
BMC Psychiatry. 2019-08-28; 19(1):
DOI: 10.1186/s12888-019-2237-x
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1. BMC Psychiatry. 2019 Aug 28;19(1):262. doi: 10.1186/s12888-019-2237-x.
Clinical guidelines for the management of treatment-resistant depression: French
recommendations from experts, the French Association for Biological Psychiatry
and Neuropsychopharmacology and the fondation FondaMental.
Bennabi D(1)(2), Charpeaud T(3), Yrondi A(4), Genty JB(5), Destouches S(5),
Lancrenon S(5), Alaïli N(6), Bellivier F(6), Bougerol T(7), Camus V(8), Dorey
JM(9)(10)(11), Doumy O(12), Haesebaert F(13), Holtzmann J(7), Lançon C(14),
Lefebvre M(13), Moliere F(15), Nieto I(6), Rabu C(16), Richieri R(14), Schmitt
L(4), Stephan F(17), Vaiva G(18), Walter M(17), Leboyer M(16), El-Hage W(8),
Llorca PM(3), Courtet P(15), Aouizerate B(9)(10)(11), Haffen E(19).
Author information:
(1)Service de Psychiatrie clinique, Centre Expert Dépression Résistante
FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences,
Université de Bourgogne Franche Comté, Besançon, France.
.
(2)Department of Clinical Psychiatry, 25030 Besançon University Hospital, 25030,
Besançon, France. .
(3)Service de Psychiatrie de l’adulte B, Centre Expert Dépression Résistante
FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
(4)Service de Psychiatrie et de Psychologie Médicale de l’adulte, Centre Expert
Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, ToNIC,
Toulouse NeuroImaging Center Université de Toulouse, Inserm, UPS, Toulouse,
France.
(5)SYLIA-STAT, 10, boulevard du Maréchal-Joffre, 92340, Bourg-la-Reine, France.
(6)Service de Psychiatrie adulte, Centre Expert Dépression Résistante
FondaMental, Hôpital Fernand-Widal, Paris, France.
(7)Service de Psychiatrie de l’adulte, CS 10217, Centre Expert Dépression
Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France.
(8)Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante
FondaMental, CHRU de Tours, Université de Tours, Inserm U1253 imaging and Brain
: iBrain, Tours, France.
(9)Old Age Psychiatry Unit, pôle EST, Centre Hospitalier le Vinatier, Bron,
France.
(10)Brain Dynamics and Cognition, Lyon Neuroscience Research Center, INSERM
U1028, CNRS UMR 5292, Lyon, France.
(11)Geriatrics Unit, CM2R, Hospices civils de Lyon, Hôpital des Charpennes,
Villeurbanne, France.
(12)Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression
Résistante FondaMental, CH Charles Perrens, UMR INRA 1286, NutriNeuro,
Université de Bordeaux, Bordeaux, France.
(13)Service universitaire des pathologies psychiatriques résistantes, Centre
expert FondaMental, PSYR2 Team, Lyon Neuroscience Research Center, INSERM U1028,
CNRS UMR5292, Centre Hospitalier Le Vinatier, University Lyon 1, Bron, France.
(14)Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La
Conception, Marseille, France.
(15)Département des Urgences et Post-Urgences Psychiatriques, Centre Expert
Dépression Résistante FondaMental, CHU Montpellier, University of Montpellier,
Montpellier, France.
(16)DHU PePSY, Pole de psychiatrie et d’addictologie des Hôpitaux Universitaires
Henri Mondor, Université Paris Est Créteil, Créteil, France.
(17)Service hospitalo-universitaire de psychiatrie d’adultes et de psychiatrie
de liaison – secteur 1, Centre Expert Dépression Résistante Fondamental, CHRU
Brest, hôpital de Bohars, Bohars, France.
(18)Service de Psychiatrie adulte, Centre Expert Dépression Résistante
FondaMental, CHU de Lille, Hôpital Fontan 1, Lille, France.
(19)Service de Psychiatrie clinique, Centre Expert Dépression Résistante
FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences,
Université de Bourgogne Franche Comté, Besançon, France.
BACKGROUND: Clear guidance for successive antidepressant pharmacological
treatments for non-responders in major depression is not well established.
METHOD: Based on the RAND/UCLA Appropriateness Method, the French Association
for Biological Psychiatry and Neuropsychopharmacology and the fondation
FondaMental developed expert consensus guidelines for the management of
treatment-resistant depression. The expert guidelines combine scientific
evidence and expert clinicians’ opinions to produce recommendations for
treatment-resistant depression. A written survey comprising 118 questions
related to highly-detailed clinical presentations was completed on a
risk-benefit scale ranging from 0 to 9 by 36 psychiatrist experts in the field
of major depression and its treatments. Key-recommendations are provided by the
scientific committee after data analysis and interpretation of the results of
the survey.
RESULTS: The scope of these guidelines encompasses the assessment of
pharmacological resistance and situations at risk of resistance, as well as the
pharmacological and psychological strategies in major depression.
CONCLUSION: The expert consensus guidelines will contribute to facilitate
treatment decisions for clinicians involved in the daily assessment and
management of treatment-resistant depression across a number of common and
complex clinical situations.
DOI: 10.1186/s12888-019-2237-x
PMCID: PMC6712810
PMID: 31455302 [Indexed for MEDLINE]
Conflict of interest statement: No financial support was received for this study
and there are no potential conflicts of interest to declare. Regarding financial
support unrelated to the present article, we disclose that N. Alaïli has
benefited from financial support for conferences and has been scientific
responsible and experimenter for preclinical studies from Servier laboratories.
B. Aouizerate has perceived honoraria to communicate at conferences from
Laboratories AstraZeneca, Lundbeck and Janssen. V. Camus has benefited from
honoraria and financial support for conferences from Laboratories Otsuka,
Novartis, Lundbeck, Servier, Janssen and has been experimenter for studies from
Janssen and Lilly. T. Charpeaud has benefited from honoraria and financial
support for conferences from Laboratories AstraZeneca, Janssen and Lundbeck and
has been experimenter for studies from Janssen. P. Courtet has benefited from
honoraria and financial support for conferences, training action and for
participation in experts groups from Servier and Janssen. O. Doumy has benefited
from honoraria and financial support for conferences from Lilly, AstraZeneca,
Servier, Lundbeck and Janssen. JM. Dorey has benefited from honoraria for
conferences from Lundbeck. W. El-Hage has benefited from honoraria and financial
support for conferences, training action and for participation in experts groups
from Lundbeck, Janssen, and Otsuka. F. Haesebaert has benefited from financial
support for conferences, grant from BMS and AstraZeneca, training grant from
Servier and a research grant from « Fonds de Recherche du Québec – Nature et
Technologie (#200123) » and has been experimenter for studies from Janssen. E.
Haffen has benefited from honoraria and financial support for conferences,
training action and for participation in experts groups from AstraZeneca, BMS,
Euthérapie u e Servier, Janssen, Livanova, Lundbeck, Otsuka and has been
experimenter for studies from Janssen. J. Holtzmann has benefited from honoraria
and financial support for conferences from Lundbeck, Servier has been
experimenter for studies from Janssen. C. Lançon has benefited from honoraria
and financial support for training action from Lundbeck. P.-M. Llorca has
benefited from honoraria and financial support for conferences, training action
and for participation in experts groups from Janssen, EISAI, Lundbeck, Otsuka,
Allergan. F. Moliere has benefited from honoraria for conferences from Lundbeck,
Otsuka. G. Vaiva has benefited from honoraria and financial support for
conferences, training action and for participation in experts groups from
Janssen and Otsuka. A. Yrondi has benefited from honoraria and financial support
for conferences from Lundbeck, Janssen, AstraZeneca; for participation in
experts groups from Lundbeck and has participated in reseach studies from
Lundbeck.