Les apports de « l'Evidence-Based Medicine » (médecine basée sur les preuves) ou comment optimiser la prise en charge de l'épisode dépressif majeur

In the early 1980s, Evidence-Based Medicine (EBM) has been developed in the Department of Clinical Epidemiology at McMaster Medical School in Canada to meet the ever-increasing need to integrate publications in clinical practice. In this approach, we cannot ever consider that the evidence will replace clinical experience. The quality of scientific data is prioritized taking into account the methodological characteristics of studies. It takes time to learn and practice the method, which is often difficult in daily practice. The concept of “management recommendations” covers multiple realities. It can rely on the results of clinical trials (randomized, controlled or not…), the trends from the meta-analysis that attempt to “simplify” the field of literature or the Clinical Practice Guidelines. Meta-analysis should be used with caution. They do not preclude the need to use the data “sources”, but they help the comparability of results and synthesis work. However it should be aware that this is a work of interpretation. The controversy over the action of antidepressants compared to placebo in depression according to the severity of the episode shows that a result depends on the included studies, the statistical technique used, but also how the results are reported. The international literature produced many recommendations in the management of depression. It is useful to refer to it as the meta-analysis because they provide an overall view of the current state of knowledge. We can regret the lack of recent French recommendations that could articulate the specifics of the French practice and data from the literature. The use of guidelines in clinical practice remains low in all fields of medicine. However improving the consideration of the recommendations is an important issue because it is associated with improved patient care. It remains to develop a collective strategy to implement them. The Evidence-Based Medicine is a major change in the everyday clinical practice. It may be insufficiently known and understood, seems too complex, time-consuming and therefore inapplicable. We have to mobilize our efforts to improve our practices.