Resistant depression plunges sufferers and their families into deep despair. What to do when nothing seems to work? New solutions exist.
Depression is not just a temporary drop in morale. It is a disease that affects one in five people during their lifetime. and France is one of the most affected countries in the world. It is involved in 80% of the 10,000 suicides recorded each year in the country. The majority of patients end up cured, but a significant proportion remains on the sidelines because no treatment works. It is estimated that 1 million people suffer from “resistant depression”. “It is depression that produces the most despair. We can welcome a family who, for 20 years, has accompanied someone who has withdrawn and nothing happens“, underlines Emmanuelle Rémond, president of Unafam (National Union of Families and Friends of Sick or Disabled People), during a press conference organized on this public health issue.
We officially speak of “resistant” depression when the patient’s condition does not improve significantly after having tested at least two different antidepressant treatments followed rigorously (sufficient dose and duration of at least 6 weeks), associated with psychotherapy. “It is recognized by the persistence of an acute “moral pain”, comparable in intensity to physical pain.“, specifies Professor Antoine Pelissolo, psychiatrist. It is therefore not just sadness but a total loss of energy, motivation and pleasure, which brings life to a standstill.
This severe form of depression is distinguished by its duration and its refractory nature, plunging the patient into chronic isolation and considerably increasing the risk of suicide. To understand why this depression persists, the psychiatrist explains that it is necessary to carry out an investigation : “We will look in depth for associated causes. We must act like a detective and look for what, alongside depression, prevents healing“. Resistance to depression is usually explained by a complex mix of three factors. One, on a biological level, undetected health problems (thyroid, inflammation) can block the effect of antidepressant medications.
Two, on a psychological level, old traumas or shocks can leave such deep traces that traditional care is no longer enough. Finally, on a social level, loneliness and precariousness act as real barriers to healing. The combination of these obstacles requires further medical expertise to find a way out. “This state is toxic in the long term on the brain. Over time, we risk weakening cognitive resources (memory, attention). It’s an emergency to be treated“, insists the psychiatrist.
Hope remains, because “resistant” does not mean “incurable”. “Depression does not resist everything, it resists a response that would only be chemical (antidepressants)“. To break the deadlock, new solutions exist: stimulation techniques such as rTMS, which uses painless magnetic pulses to reactivate sleeping areas of the brain without anesthesia, or ECT (electroconvulsive therapy), which allows a “reset” of neural circuits under brief anesthesia for the most severe cases. The arrival of new molecules such as esketamine nasal spray (Spravato) offers rapid results for certain patients. Even if it is a spray, it is not taken at home. Administration must be done in a health establishment under medical supervision (approximately 2 hours) to monitor blood pressure and possible temporary “disconnection” (dissociation) effects.
In the context of resistant depression, CBT (Cognitive and Behavioral Therapies) is no longer limited to basic exercises, but is adapted to break thought patterns anchored for years. They are often carried out more intensively, sometimes in a day hospital, to provide a safe and regular environment for the patient and their family.
