[Guidelines and reality in practical use of and compliance to antidepressants in the treatment of depression: incidence survey in Lorraine and Champagne-Ardenne (France)]. / Réalités et recommandations dans la prescription et l'observance des antidépresseurs en médecine générale : évaluation des pratiques dans le traitement de la dépression en Lorraine et Champagne-Ardenne.

INTRODUCTION: In 2002, the French regulatory authority Anaes issued official guidelines in the pharmacological treatment of depression, which have been widely publicised within the french medical profession. The aim of the study was to evaluate the actual prescription of antidepressants (AD) in general clinical practice and assess potential deviations in reference to these guidelines and recommendations. METHODS: This is a retrospective study in ambulatory patients, treated with an AD for depression by general practitioners. The cohort was composed of incident cases during 2003 in the Lorraine and Champagne-Ardenne catchment areas of the french healthcare system (URCAM). Patients had to answer a questionnaire, administred during a clinical interview by a trained physician belonging to the URCAM, in order to document the characteristics, efficacy and tolerance of the prescribed drugs as well as compliance and reasons for non compliance, according to patients' views and opinions. RESULTS: Six hundred and thirty-two persons (71.2% women and 38.2% men, mean age: 48.6) answered the questionnaire. The incidence of depression, treated with AD, was estimated at 3.65/100 persons-years. Sixty-one percent of the patients were treated for a first depressive episode, 13% for a second and 8% for a third episode. Eighteen percent had been treated for four or more episodes. The drugs prescribed were selective serotonin reuptake inhibitors (SSRI) and serotonin-noradrenaline dopamine reuptake (SNRI) in 80.5% of the cases, tricyclics in 6.2% cases and 91.2% of the SSRI-SNRI were prescribed at adequate daily doses, according to recommendations, whereas tricyclics and other antidepressants were inadequately at low regimens. The duration of AD treatment was adequate (> or =6 months) in 63.6% cases for tricyclics, but only 45.8% in cases for SSRI or SNRI and 39.2% for other AD. Altogether, there were adequate treatments for only 40.2% of the SSRI and the SNRI, 21.3% of other AD and only 18.8% of tricyclics. Treatment was discontinued in overall 58.1% cases on patients' initiative and this percentage reached 71.3% in the case of premature withdrawal (<6 months). The feeling of being cured (47.6%) and occurrence of side effects (23.6%) were the main reasons mentioned by patients for discontinuing treatment. CONCLUSION: The discrepancies and deviations according to official guidelines demonstrate the need for continued education of professionals, for implementation of standards of practice and for large scale public opinion information, in order to durably change attitudes and behavior towards depression and its treatment.

MEP (Mars Environment Package): toward a package for studying environmental conditions at the surface of Mars from future lander/rover missions.

In view to prepare Mars human exploration, it is necessary to promote and lead, at the international level, a highly interdisciplinary program, involving specialists of geochemistry, geophysics, atmospheric science, space weather, and biology. The goal of this program will be to elaborate concepts of individual instruments, then of integrated instrumental packages, able to collect exhaustive data sets of environmental parameters from future landers and rovers of Mars, and to favour the conditions of their implementation. Such a program is one of the most urgent need for preparing human exploration, in order to develop mitigation strategies aimed at ensuring the safety of human explorers, and minimizing risk for surface operations. A few main areas of investigation may be listed: particle and radiation environment, chemical composition of atmosphere, meteorology, chemical composition of dust, surface and subsurface material, water in the subsurface, physical properties of the soil, search for an hypothesized microbial activity, characterization of radio-electric properties of the Martian ionosphere. Scientists at the origin of the present paper, already involved at a high degree of responsibility in several Mars missions, and actively preparing in situ instrumentation for future landed platforms (Netlander--now cancelled, MSL-09), express their readiness to participate in both ESA/AURORA and NASA programs of Mars human exploration. They think that the formation of a Mars Environment working group at ESA, in the course of the AURORA definition phase, could act positively in favour of the program, by increasing its scientific cross-section and making it still more focused on human exploration.