Strengthened professional training, graduated care pathway, equitable access to therapies: through advocacy, several psychiatrists and the patient and family associations France Dépression and Unafam are formulating five concrete proposals to “upgrade” the treatment of resistant depression, which affects nearly a million people in France.
Resistant depression is too often “synonymous with therapeutic wandering”denounce, in a joint press release from psychiatrists, the patient and family associations France Dépression and the National Union of Families and Friends of Sick and/or Mentally Disabled People (Unafam). To better support it, the collective of specialists and associations, which also includes Professor Amine Benyamina, makes five proposals:
Strengthen the initial and continuing training of health professionals in its identification and managementthanks to tools that Public Health France (SpF) will have to develop, particularly because early detection makes it possible to “better treat depression, preventing it from becoming resistant”, while “the peak onset of psychiatric illnesses, particularly anxiety and depression, occurs at age 14 and a half« specifies child psychiatrist Professor Olivier Bonnot, new president of the National Council of Academic Psychiatry (CNUP).
The collective thus offers “to integrate resistant depression into the teaching of psychiatry and general medicine, into medical studies, in conjunction with the National Council of Universities in Psychiatry and university colleges”, or even “the development of dedicated educational modules relating to identification, therapeutic gradation, therapeutic innovations and the management of comorbidities”. The collective also recommends “to include the theme among the priority orientations of Continuing Professional Development (CPD)”.
Graduated care pathway and equitable access to therapies
Among the other proposals, the authors of this plea defend an awareness campaign for health professionalsthanks in particular to the development of decision support tools by Public Health France (clinical files, decision trees), the dissemination of information via the channels of Health Insurance and the Order of Physicians or even the integration of identification tools directly into doctors’ prescription software.
The signatories also call for the establishment of a graduated care pathway combining community medicine, specialized structures and expert centers, also taking care of patients’ comorbidities and addictions. In terms of implementing this proposal, the collective suggests “ a saisine or self-referral to the High Authority of Health in order to develop national recommendations specifying the criteria for resistant depression, therapeutic strategies according to the lines of treatment and methods of referral to different levels of appeal » or even “the publication of a ministerial instruction asking regional health agencies to integrate this pathway into regional health projects and to identify referral structures in their territory (hospital psychiatry, expert centers, addiction treatment systems)”.
Finally, they plead for a« equitable access to therapeutic approaches in psychiatry »with harmonized support. For example, the authors would like the HAS to develop a benchmark of good practices covering diagnosis and monitoring, the dissemination of these recommendations to professionals via learned societies and training organizations and the integration of these criteria into the quality certification processes of health establishments.
For ten or twelve years, none of the doctors I saw – psychoanalyst, general practitioner, psychiatrist – said to themselves: “He is being force-fed with medication and yet he remains in the same state… there is a problem! ». This medical wandering, the absence of diagnosis, leads you to absolutely monstrous states of psychological suffering, of which we have no idea. Medical wandering kills.
Excerpts from the interview “I am mentally ill”, Nicolas Demorand, Le Point, n° 2749, March 27, 2025.
Cause de mortalité prématurée (10 à 12 000 suicides et 176 000 tentatives de suicides lui sont imputés) et de surmortalité (cancers, maladies cardiovasculaires...), la dépression résistante ou sévère altère les fonctions cognitives, ce qui compromet le retour à l'emploi et coûte 14 milliards d'euros par an à la collectivité (arrêts de travail...), selon l'Organisation de coopération et de développement économiques (OCDE).
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