Incidence de la dépression résistante lors du premier épisode dépressif

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Publiée Aug 24, 2023
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Vol. 101 No 3 (2023): Tunis Med mar 2023

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Maroua Said
Public Mental Health Establishment in Marne (France).
Rania Hosni
Psychiatry Department A, Razi hospital, Tunis, Tunisia
Hend Jemli
Psychiatry Department A, Razi hospital, Tunis, Tunisia
Yosra Zgueb
Psychiatry Department A, Razi hospital, Tunis, Tunisia
Uta Ouali
Psychiatry Department A, Razi hospital, Tunis, Tunisia
Haifa Zalila
Outpatient Psychiatry Department, Razi Hospital, Tunisia
Fethi Nacef
Psychiatry Department A, Razi hospital, Tunis, Tunisia
Rabaa Jomli
Psychiatry Department A, Razi hospital, Tunis, Tunisia

Résumé

Introduction : La dépression représente un problème majeur de santé publique. Le préjudice de cette maladie, est dû pour une part importante à
la résistance, qui peut aboutir à la chronicité.
Objectif : Estimer l’incidence de la dépression résistante au cours d’un premier épisode dépressif majeur et rechercher les facteurs
sociodémographiques et cliniques associés à cette résistance.
Méthodes : Une étude descriptive longitudinale et prospective a été menée, auprès des consultants à l’hôpital Razi, pour un premier épisode
dépressif majeur. Les patients inclus dans l’étude ont été mis sous traitement antidépresseur, à base de fluoxétine ou sertraline. La première phase
de traitement a consisté de suivre la réponse au premier antidépresseur avec un contrôle tous les quinze jours et une augmentation de la dose
jusqu’à la dose maximale. En l’absence de réponse au premier antidépresseur, un swich pour le deuxième antidépresseur est fait avec contrôle
tous les quinze jours et augmentation de la dose jusqu’à la dose maximale. Les participants ont été suivis régulièrement jusqu’à l’obtention d’une
réponse thérapeutique ou bien la réunion des critères d’une dépression résistante.
Résultats : Notre étude a intéressé 82 patients, ayant un âge moyen de 44,5±11,1 ans. Des antécédents familiaux de trouble dépressif ont été
notés chez 17,3% des patients, de trouble bipolaire chez 11,1%, de trouble psychotique chez 13,6%, et de trouble anxieux chez 14,9%, alors
que 14,7% avaient un trouble de la personnalité. Chez notre population, le taux de réponse au premier antidépresseur était de 47,2%. Le taux
de réponse au deuxième antidépresseur était de 57,1%. L’incidence de la dépression résistante, chez notre population, était de 19,4%. Une
association statistiquement significative entre la dépression résistante et la présence d’antécédents familiaux de psychose d’une part, et d’autre
part avec les comorbidités respiratoires chroniques a été retrouvée.
Conclusion: L’incidence de la dépression résistante dans ce travail se situe dans la limite inférieure des chiffres de prévalence de la résistance
rapportés dans la littérature. Les facteurs cliniques prédictifs de résistance contribuent probablement à identifier ces patients. Dans le futur,
l’analyse génotypique permettra probablement une évaluation plus sensible et plus précoce de la réponse thérapeutique.

Mots-clés :

dépression résistante, Incidence, fluoxetine, sertraline

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