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[Depressive disorders and public health: a review of the economic impact].

Budgetary control policies implemented in order to cope with the increase in health costs in industrialized countries and with the desequilibrium of the national health insurance accounts, give rise to the problem of preserving the quality of care and quality of life of the patients. Only health economic studies, evaluating the possible different therapeutic strategies, will enable us to reconcile the 2 terms of the equation whose contradiction might be only apparent. This is particularly true for the treatment of psychiatric diseases, and especially depression. Budgetary control cannot be reduced to a simple management of penury, since the cheapest treatments are not necessarily the most profitable. In this context, new strategies are proposed: it is suggested that thorough diagnosis (avoiding both the non acknowledgement of the illness and the overconsumption of antidepressants) and early optimal treatment, of adequate duration, of the depressive disorders might be the most economic attitude in the management of this pathology. On the other hand, the impact of the treatment of depression on the quality of life of the patient has a direct effect on costs if one considers the supplement to medical consumption and the social deficit induced by therapeutic failure. It remains that the evaluation of the health economics of depression is difficult because of the complexity of the parameters involved. Though rather well developed in the UK and in North America, this evaluation still has to be introduced in France.