[The depressed patient: remission or recovery?]

Abstract

Since Kraepelin's works, depressive disorders have been considered as transient pathological episodes which are easily cured with antidepressive medications. Among these disorders, only manic-depressive illness, due to its periodic course, and neurotic depression, prone to recurrences and chronicity, do not fit with this model. In fact, many recent studies, conducted for the most part on large samples of depressive patients followed during a long period of time (many years), lead to other perspectives. it seems that, for most of the patients if not for all of them, recurrence and chronicity should be the rule. Comorbid personality disorders are of some importance for the course of depressive disorders but cannot explain why so many depressive patients experience recurrences of the disease. Some new hypothesis are investigated and one of them, proposed by R. Post and colleagues, postulate that stressors, like some life events, can induce transcription factors (mainly the proto-oncogene c-fos) which then affect neurotransmitters and, by consequence, the responsibility of the limbic system. Thus, these neurobiological changes could lead to further occurrences of depressive illness in patients who had experienced one depressive episode. All these data highlight the critical importance of early therapeutic intervention in the illness and of sustained maintenance treatment in order to avoid recurrences or chronicity.