Can We Predict the Evolution of Major Depressive Disorder

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Presenting Author(s): Dr. Philip Gorwood, MD, PhD

Co-Author(s): Rebecca Perrain and Lila Mekaoui

Date and time: 19 Mar 2020 from 18:00 to 20:00

Location: Wildrose Salon C  Floor Map

Learning Objectives:

  1. Knowing risk factors of recurrence in unipolar depression;
  2. Adapt treatment strategies to reduce each risk factor; and
  3. Conceptualize MDD cognitive impairment as consequences of recurrence.


After the first depressive episode, only one patient out of two will have at least another episode, but the risk of recurrence increases with each episode, getting closer to 100% after the 15th episode. This relatively negative outcome is also a signal that, potentially, preventing an episode could not only protect the patient from a difficult period of depressed months, but might also block this vivious circle, implying lifetime benefits. We will sum-up the most reliable factors on which the clinician may intervene, such as speed of diagnosis, optimize what is already
done, treat anxiety and other comorbidities, focus on compliance, associate other strategies than pharmacological treatment (psychotherapy, sport, tDCS...), focus on cognitions instead of emotions only, use symptom profile and make shared-decision with the patient.

Literature References:

1. Voegeli G, Cléry-Melin ML, Ramoz N, Gorwood P. Progress in Elucidating Biomarkers of Antidepressant Pharmacological Treatment Response: A Systematic Review and Meta-analysis of the Last 15 Years. Drugs. 2017 Dec;77(18):1967-1986.

2. McIntyre RS, Anderson N, Baune BT, Brietzke E, Burdick K, Fossati P, Gorwood P, Harmer C, Harrison J, Harvey P, Mansur RB, Medalia A, Miskowiak K, Ramey T, Rong C, Rosenblat JD, Young A, Stahl SM. Expert Consensus on Screening and Assessment of Cognition in Psychiatry. CNS Spectr Feb;24(1):154-162.

3. Gorwood P, Richard-Devantoy S, Sentissi O, LeStrat Y, Olié JP (2016) The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients. Psychiatry Research 240: 288–294.

4. Gorwood P, Vaiva G, Corruble E, Llorca PM, Baylé F, Courtet P (2015) The ability of early changes in motivation to predict later antidepressant treatment response. Neuropsychiatric Disease and Treatment;11:2875-2882.

5. Nobile B, Ramoz N, Jaussent I, Gorwood P, Olié E, Lopez-Castroman J, Guillaume S, Courtet P. Polymorphism A118G of opioid receptor mu 1 (OPRM1) is associated with emergence of suicidal ideation at antidepressant onset in a large naturalistic cohort of depressed outpatients. Sci Rep. 2019 Feb 22;9(1):2569.

6. Clery-Melin ML, Gorwood P, Friedman S, Even C (2018) Stability of the diagnosis of seasonal affective disorder in a long-term prospective study. Journal of Affective Disorders, 2018 Feb;227:353-357

7. Kingslake J, Dias R, Dawson GR, Simon J, Goodwin G, Harmer CJ, Morriss R, Brown S, Guo B; Henricus G. Ruhe; Anne Lever; Dick J. Veltman; Anneke van Schaik; Jurgen Deckert; Andreas Reif; Michael Stablein; Andreas Menke; Gorwood P, Voegeli G, Perez V, Browning M (2017) An interventional, randomised, open label, multi-centre, parallel-group, controlled study investigating the effects of using the PReDicT Test to guide the antidepressant treatment of depressed patients. Trials, 2017 Nov 23;18(1):558.

9. Stauffer V, Liu P, Goldberger C, Marangell L, Nelson C, Gorwood P, Fava M (2017) Is the Noradrenergic Symptom Cluster a Valid Construct in Adjunctive Treatment of Major Depressive Disorder? Journal of Clinical Psychiatry, 78(3):317-323.

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