On the occasion of Blue Monday, January 17, 2022, the “most depressing day of the year”, 2 doctors are examining the link between depression and memory, as well as the usefulness of psychotropic drugs. And what regarding the impact of the pandemic on our morale?
What is Blue monday? The day considered the most depressing of the year by a British TV channel in 2005. The term more generally refers to weekly changes in mood and the idea that Monday is the saddest day of the day. week. This “Blue Monday” is celebrated on the third Monday in January. In 2022, it therefore falls on the 17th. On this occasion, the Observatoire B2V des Mémoires examined the links between memory and depression. Several avenues are explored by Francis Eustache, neuropsychologist, and Catherine Thomas-Antérion, neurologist and doctor in neuropsychology, both members of the scientific council of this Observatory which, created in 2013, has the mission of studying memory in all its forms. Their responses …
Question: What does depression mean?
Responnse : Depression is a generic term that groups together very different situations. It concerns a young or old person, a single or recurrent episode, and we distinguish simple depression or with or without other psychological disorders (comorbidities). The depressed person presents a sad mood, a loss of interests, a decrease in vitality and activity; this drop in speed is felt to be a source of fatigue. The patient suffers from a lack of confidence and self-esteem, feelings of guilt or worthlessness. Thoughts of suicide are a worrisome symptom, with a risk of suicide proportional to the severity of the depression. Other symptoms are constant such as sleeping and eating disorders.
Q: Can it cause memory loss?
R : Depression is not a memory disease, like Alzheimer’s disease, which is often seen as the prototype for these diseases. Mood disorders will however lead to memory problems due to difficulty concentrating and ideomotor slowing down. Insomnia also affects the quality of healing due to sleep disturbances. In Alzheimer’s disease, authentic memory disorders are observed, that is, the person fails to record (encode) new information, while forgetting information and memories that they had. yet acquired in his past. In depression, it is more a question of “apparent” disorders. The person with depression has difficulty recalling information spontaneously (in memory tests, this corresponds to the conditions of free recall). On the other hand, and unlike Alzheimer’s disease, the depressed person is helped by recall clues (the beginning of the words presented in the encoding phase or their semantic category: it was a name of animal, of fruit etc.) while these clues are of little help to the patient suffering from Alzheimer’s. In addition to the temporarily altered memory mechanisms, the contents can be modified. Dark thoughts invade memories which, in turn, invade the thoughts of the depressed person causing a kind of vicious circle. Another notable point is the distortion of the perception of time and of the projection into the future with the impression of an accelerating time. Episodic biographical memories are sparse, blunt and “overgeneralized” because the depressive is withdrawn during the episode with a blunt emotion and entirely focused on sadness.
Q: What are the traces of depression on our brains?
R : Research in neuroscience, which uses in particular functional brain imaging methods, goes in the same direction as the clinical descriptions and shows a dysfunction of the circuits which unite the prefrontal regions (in front of the brain) and the hippocampi, involved in memory. episodic. These alterations are in good agreement with the recall (retrieval) difficulties that are observed in memory tests. It is not really the mechanisms of memory that are affected but more the strategies that allow memory to function well. These observations are made in the context of research on groups of patients. They are of little use in routine clinics, in a single patient, unlike Alzheimer’s disease where brain imaging methods play a major role in the diagnosis.
Q: In the event of depression, is it necessary to prescribe psychotropic treatments (which aim to “normalize the mood”)?
R : This is a very complex question on which it is difficult to generalize given the variability of the situations. We can cite, in particular: the age of the patients, their co-morbidities (i.e. other possible psychic weaknesses or the consumption of toxicants: alcohol, cannabis, etc.), the type of depression (reaction to a life test or endogenous). The consensus message, in particular that of the recommendations of the High Authority for Health (HAS) in 2017, is to say that supportive psychotherapy, carried out including by the general practitioner, can be offered without recourse to medication only in cases of depression. moderate and always with an evaluation at four or eight weeks to review the need to introduce or not drug treatment. In the event of severe depression which requires it from the outset, it is always recommended to accompany the drug with psychotherapy and, when possible, with support from those around it. The antidepressant treatment is chosen according to the sick person and the symptoms requiring it, and always in the doctor-patient alliance.
Q: Do these treatments have any cognitive side effects?
R : Most often, people testify, by regaining sleep, vitality and by reducing gloomy ideas, a better functioning, for example: ” I start to be able to read once more without forgetting what I just read on the previous page ».
Q: Even under treatment with benzodiazepines?
R : Benzodiazepines, especially long-lived ones, are responsible for many side effects following 65 years. This is why they are no longer prescribed for short periods of time in the context of depression, for example in cases of persistent insomnia. According to a 2012 HAS report: “ The benefit / risk balance is clearly unfavorable for chronic treatments, with a number of potentially serious adverse effects and a source of hospitalization and excess mortality: falls, cognitive disorders, psychomotor and behavioral disorders, road accidents, loss of autonomy , occurrence of tolerance and dependence, even risk of suicide according to a recent study. Finally, a certain number of epidemiological studies raise the question of an increased risk of major cognitive disorders (Alzheimer’s disease but not only) during their prolonged consumption, which has led to a warning message from the ‘ANSM (National Medicines Safety Agency) and a reflection on their prescription.
Q: Do we already have enough hindsight to know the impact of the pandemic on our brains and our mental health?
R : The Covid-19 pandemic and the confinement situations have resulted, for some people with or without a history of psychological fragility, a real ordeal, however with great disparities according to social groups and confinement situations. Numerous studies have been carried out at different times during this health crisis. In particular, an increase in anxiety has been demonstrated, sometimes followed by depressive symptoms. It is now important to follow regular surveys such as those carried out by Public Health France to estimate the lasting effects of such an anxiety-provoking situation in these people. It has also been recorded an increase in addictions, an element of vulnerability to depression and frequent comorbidity, which requires complex studies taking into account many parameters.
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