[Antidepressive agents: benefits/risks].

Abstract

In 1994, the risk/benefit ratio when using antidepressant drugs for the treatment of mood disorders has become very difficult to assess. From the medical standpoint, frequent nosographical modifications generated new clinical entities (brief recurrent depression, subsyndromal depression, mixed anxiety and depression according to the ICD 10, dysthymia). Within these entities, mood appears modified in duration and severity and belongs to extremely different structures. The obvious link between antidepressants and typical depression has to be thoroughly assessed for these new forms of illness. But the evolution of medical and economical assessment techniques progressively turns the attributed risk into a global index based on group results far from the dual patient-physician relationship in which the risk/benefit ratio is assessed according to idiosyncratic criteria. The development of a dimensional clinical field could, if misused, be reduced to an addition of "target treatments". Finally, some antidepressants are no longer presented for their main antidepressive effects (for which their use is authorized) but for peripheral properties: treatment strategies (particularly duration) remain unclear for these latter effects. From a sociological point of view, consequences of consumerism, social and economical crisis and modifications of the image of the psychiatry, play a role in the evaluation of this risk/benefit ratio.