Significant Need for a French Network of Expert Centers Enabling a Better Characterization and Management of Treatment-Resistant Depression (Fondation FondaMental).
Front. Psychiatry. 2017-11-24; 8:
DOI: 10.3389/fpsyt.2017.00244
Lire sur PubMed
1. Front Psychiatry. 2017 Nov 24;8:244. doi: 10.3389/fpsyt.2017.00244.
eCollection 2017.
Significant Need for a French Network of Expert Centers Enabling a Better
Characterization and Management of Treatment-Resistant Depression (Fondation
FondaMental).
Yrondi A(1), Bennabi D(2), Haffen E(3), Garnier M(4), Bellivier F(5), Bourgerol
T(6), Camus V(7), D’Amato T(8), Doumy O(9), Haesebaert F(8), Holtzmann J(6),
Lançon C(10), Vignaud P(8), Moliere F(11), Nieto I(5), Richieri RM(10), Domenech
P(12), Rabu C(12), Mallet L(12), Yon L(12), Schmitt L(1), Stephan F(13), Vaiva
G(14), Walter M(13), Llorca PM(4), Courtet P(11), Leboyer M(12), El-Hage W(7),
Aouizerate B(9).
Author information:
(1)Service de Psychiatrie et de Psychologie Médicale de l’adulte, Centre Expert
Dépression Résistante FondaMental, CHRU de Toulouse, Hôpital Purpan, Toulouse,
France.
(2)Service de Psychiatrie clinique, Centre Expert Dépression Résistante
FondaMental, EA 481 Neurosciences, Université de Bourgogne Franche Comté,
Besançon, France.
(3)Service de Psychiatrie clinique, Centre Expert Dépression Résistante
FondaMental, Centre Investigation Clinique 1431-INSERM, EA 481 Neurosciences,
Université de Bourgogne Franche Comté, Besançon, France.
(4)Service de Psychiatrie de l’adulte B, Centre Expert Dépression Résistante
FondaMental, CHU de Clermont-Ferrand, Clermont-Ferrand, France.
(5)Service de Psychiatrie adulte, Centre Expert Dépression Résistante
FondaMental, Hôpital Fernand-Widal, Paris, France.
(6)Service de Psychiatrie de l’adulte, CS 10217, Centre Expert Dépression
Résistante FondaMental, CHU de Grenoble, Hôpital Nord, Grenoble, France.
(7)Clinique Psychiatrique Universitaire, Centre Expert Dépression Résistante
FondaMental, Inserm U1253 imaging and Brain:iBrain, CHRU de Tours, Tours,
France.
(8)Service Universitaire de Psychiatrie adulte, Centre Expert Dépression
Résistante FondaMental, Centre Hospitalier Le Vinatier, Bron cedex, France.
(9)Pôle de Psychiatrie Générale et Universitaire, Centre Expert Dépression
Résistante FondaMental, CH Charles Perrens, Bordeaux, France.
(10)Pôle Psychiatrie, Centre Expert Dépression Résistante FondaMental, CHU La
Conception, Marseille, France.
(11)Département des Urgences et Post-Urgences Psychiatriques, Centre Expert
Dépression Résistante FondaMental, CHRU Lapeyronie, Montpellier, France.
(12)Pôle de Psychiatrie des Hôpitaux Universitaires, Centre Expert Dépression
Résistante FondaMental, Hôpital Henri Mondor, Créteil, France.
(13)Service de Psychiatrie de l’adulte, Centre Expert Dépression Résistante
FondaMental, CHU de Brest, Hôpital de Bohars, Bohars, France.
(14)Service de Psychiatrie adulte, Centre Expert Dépression Résistante
FondaMental, CHRU de Lille, Hôpital Fontan 1, Lille, France.
BACKGROUND: Major depression is characterized by (i) a high lifetime prevalence
of 16-17% in the general population; (ii) a high frequency of treatment
resistance in around 20-30% of cases; (iii) a recurrent or chronic course; (iv)
a negative impact on the general functioning and quality of life; and (v) a high
level of comorbidity with various psychiatric and non-psychiatric disorders,
high occurrence of completed suicide, significant burden along with the
personal, societal, and economic costs. In this context, there is an important
need for the development of a network of expert centers for treatment-resistant
depression (TRD), as performed under the leadership of the Fondation
FondaMental.
METHODS: The principal mission of this national network is to establish a
genuine prevention, screening, and diagnosis policy for TRD to offer a
systematic, comprehensive, longitudinal, and multidimensional evaluation of
cases. A shared electronic medical file is used referring to a common exhaustive
and standardized set of assessment tools exploring psychiatric, non-psychiatric,
metabolic, biological, and cognitive dimensions of TRD. This is paralleled by a
medico-economic evaluation to examine the global economic burden of the disease
and related health-care resource utilization. In addition, an integrated biobank
has been built by the collection of serum and DNA samples for the measurement of
several biomarkers that could further be associated with the treatment
resistance in the recruited depressed patients. A French observational long-term
follow-up cohort study is currently in progress enabling the extensive
assessment of resistant depressed patients. In those unresponsive cases, each
expert center proposes relevant therapeutic options that are classically aligned
to the international guidelines referring to recognized scientific societies.
DISCUSSION: This approach is expected to improve the overall clinical
assessments and to provide evidence-based information to those clinicians most
closely involved in the management of TRD thereby facilitating treatment
decisions and choice in everyday clinical practice. This could contribute to
significantly improve the poor prognosis, the relapsing course, daily
functioning and heavy burden of TRD. Moreover, the newly created French network
of expert centers for TRD will be particularly helpful for a better
characterization of sociodemographic, clinical, neuropsychological, and
biological markers of treatment resistance required for the further development
of personalized therapeutic strategies in TRD.
DOI: 10.3389/fpsyt.2017.00244
PMCID: PMC5706526
PMID: 29225582