[Depression and professional activity: results of the NEXTEP study]

Depression is one of the most common diseases. It is associated with a significant psychosocial disability and many studies have shown that it results in numerous sick-leaves, with substantial economic burden. However, most of the studies have been conducted in Northern Europe and the situation in France remains unknown.

To describe the management of depressive patients and assess the impact of treatment on professional activity and sick-leave.

An epidemiological observational longitudinal study (NEXTEP) performed by TNS Healthcare in private practice psychiatrists.

Data of 2516 patients included by 771 psychiatrists were analyzed. Patients aged 20 to 60 years, with professional activity and presenting with major depression were eligible if they were prescribed an antidepressant drug for the first time by this psychiatrist on the day of consultation. Women represented 65% of the cohort. Mean MADRS score at baseline was 34±7.7/60 and 47% of patients had a severe depression; only 5% had mild depression. Professional activity was impaired in 95% of cases. A sick-leave certificate was granted to 35% of the patients at the end of the first visit (first sick-leave or renewal in 14% and 21% of cases, respectively), and 100% were prescribed a pharmacological treatment (antidepressant agent). After 2 months, MADRS scores had dramatically decreased (-21 points on average) and 50% of the patients were symptom free. Most patients (75%) perceived improvement in working capacity; only 13% of patients received a sick-leave certificate. Escitalopram was associated with a significantly greater improvement in depressive symptoms, along with a significantly lower number and duration of sick-leave certificates. In multivariate analysis, predictors of depression improvement were decreased in anxiety, improved in self-esteem, and escitalopram treatment.

Frequency and duration of sick-leave appear lower than in other studies, notably those conducted in Scandinavian countries. However, employment laws are different, which may influence the physicians' attitudes.

This study is the first that accurately describes the management of depressive patients and the impact of treatment on professional activity and sick-leave in France. It suggests that an appropriate management of depressive patients results in a rapid improvement of symptoms and work resumption in most cases.