evolution of dark ideas when introducing or switching an antidepressant

Conditions: Current Major Depressive Disorder

Summary: depression is a frequent disease and a serious public health problem, of which suicide is the most severe complication. its treatment is based on the introduction of antidepressant which not only proposes a significant delay in the relief of symptoms but also by the phenomenon of lifting of inhibition can increase the suicidal risk during the initiation phase. therefore there is a major interest in proposing a monitoring of these dark and suicidal ideas, immediately after the implementation of such treatment as well as other symptoms of depression. thus, the aim of this study is to identify the mechanisms underlying this increase in dark and suicidal ideas in this context.

the study propose to assess, with an ecological momentary assessment method, the evolution of black ideas over 30 days following the introduction or switch of an oral antidepressants. 103 patients will be recruited suffering from a current major depressive disorder in the montpellier university hospital. each patient will attend a total of 3 scheduled visits, which will be completed over a period of 1 month (inclusion, between 10-15 days, 1 month. during this month, the patient will have to complete daily assesments throught a smartphone application "depasse". this servier application allows the daily monitoring of symptoms allowing a regular evaluation, in the form of smileys simulating a likert type scale evaluation of 1 to 5. 10 parameters are evaluated: moral, black thoughts, sleep, stress, concentration, social activities, energy, pleasure, motivation and libido. note that when the patient expresses dark thoughts, he is then asked if he wants to hurt himself. if he answers yes, he is then asked to contact an emergency service. one of its originalities is the addition of positive psychology approaches with a positive reinforcement of this evaluation through reward by a smiley in a smiley box and obtaining a "pleasant" image for motivation and incentive. there is the possibility to have the graphical follow-up of the various parameters and to send them by mail to his treating psychiatrist. advice adapted to the mood of the day is provided taking into account the "dysfunctional" parameters. similarly, the emergency buoy tool provides access to emergency numbers and directs the patient to seek care. intelligence of the weight and the treatments established. the app also has a notification setting to remind the patient to evaluate themselves daily.

Eligibility criteria:
inclusion criteria: * subject aged 18 to 65 * diagnosis of a characterized depressive episode assessed by the clinician * depression score : madrs\> 20 * introduction or switch of an antidepressant (without combination of molecules) * signed informed consent * able to understand the nature, purpose and methodology of the study * french language * able to understand and conduct clinical assessments. exclusion criteria: * the following psychiatric comorbidities: bipolar disorder, schizophrenia, alcohol dependence and / or any other substance objectivized during the clinical evaluation * patient presenting a depressive episode characterized with mixed component, psychotic, melancholic or catatonic characteristics * score madrs greater than or equal to 5 to one of the items * subject protected by law (guardianship or curatorship) * subject in exclusion period from another protocol * subject not affiliated to, or not beneficiary of, a social security scheme * pregnant orbreastfeeding patient

Keywords: aged between 18 and 65 major depressive disorder suicide ecological momentary assessment smartphone application