Healthcare

How to improve the management of depression to address current mental health crisis?

Published on 26 September 2025 Read 25 min

management of depression agency consulting consultancy experts

Since the COVID-19 crisis, the WHO estimates a 25% increase in major anxiety-depressive disorders worldwide. In France, the situation is particularly concerning: nearly one in five adults will experience depression during their lifetime¹, and prevalence already reached 11% in 2019, the highest rate in Europe². With an annual cost estimated at 160 billion euros, depression also represents a major economic issue for France³.

Given this situation, it is clear that strengthening the care pathway in France is necessary. In this article, Alcimed explores the main obstacles encountered at different stages of the depression care pathway, from awareness of the illness to the initiation of treatment, while identifying possible levers for action for stakeholders in the sector.

Understanding depression: Definitions and biological origins

The WHO defines mental health as a state of mental well-being that enables individuals to cope with life’s difficulties, to work, and to contribute to society¹. Among the psychiatric disorders that can affect this balance, depression is characterized by an alteration of mood, motivation, and cognitive functions, lasting at least two weeks. It differs from a temporary “low mood” by its duration but also by the intensity of symptoms and their significant impact on daily life².

On a biological level, several mechanisms may be involved in the pathophysiology of depression:

Deficit in neurotransmitters such as serotonin, dopamine, or noradrenaline,
Dysregulation of the stress axis (Hypothalamic-Pituitary-Adrenal axis), with disturbance in cortisol regulation and stress response,
Inflammatory reaction and immune system dysfunction,
Alteration of neuroplasticity, notably through a deficit in BDNF (Brain-Derived Neurotrophic Factor).

Depression is a multifactorial pathology whose neurobiological origin is not well understood and without a universal treatment.
Let us now look at the main stages of the care pathway, from the awareness of the first signs to the initiation of treatment, highlighting the obstacles encountered at each stage.

Awareness: Overcoming stigma and bridging the lack of reference points on depression

Recognition of depression as a chronic illness has progressed since the COVID-19 epidemic. In France, mental health has been declared a National Great Cause for 2025³. This mobilization is not limited to public policies; it now extends to the business world, where several awareness campaigns have emerged since the pandemic.

But this momentum faces long-standing barriers in society. According to Assurance Maladie, 70% of French people adhere to at least one negative stereotype about people with mental health disorders⁴. For many, depression is perceived as a personal weakness rather than a pathology. This stigma discourages consultation and sometimes causes more suffering than the disorders themselves⁵.

Furthermore, the lack of knowledge about symptoms greatly contributes to delaying the recognition of the first signs of depression. And although mental health education or early detection policies are emerging in schools, universities, or workplaces, they remain insufficient to date⁶⁷. In the absence of sufficient awareness, common symptoms such as fatigue, chronic pain, or sleep disorders are often ignored or trivialized. Without reference points, many people wait for it to “pass,” without imagining they could be suffering from depression.

To address these issues of stigma and lack of reference points, several levers could be activated by health stakeholders: supporting educational campaigns and training (e.g., PSSM⁸), supporting and collaborating with associations (e.g., PSYCOM⁹) to strengthen anti-stigma campaigns.

Pre-diagnosis: Facilitating access to specialists

The general practitioner is often the first professional consulted in cases of depressive disorders. However, the diagnosis is difficult to make: symptoms are often non-specific, consultation time is limited, and the use of screening tools remains limited.

In case of suspicion, the general practitioner can refer to a psychiatrist or psychologist, but access remains difficult. Some French departments have fewer than 9 psychiatrists per 100,000 inhabitants¹⁰, with consultation delays that can exceed several weeks¹¹. Beyond the availability of healthcare professionals, the cost of consultations is another barrier to specialized care: initiatives such as “Mon Soutien Psy” are being developed, but out-of-pocket expenses prevent some patients from benefiting in the long term¹².

Finally, due to a lack of suitable local structures or effective referral, many patients in distress turn to hospital structures (of which 11% had consulted neither a general practitioner nor a psychiatrist beforehand¹³). Yet here again, care is constrained by a lack of resources: the continuous decrease in the number of psychiatric beds and the saturation of emergency departments, often used by default, make the management of distress situations even more complicated¹⁴.

To improve this pre-diagnosis stage, several courses of action are available to health stakeholders: developing individualized pre-diagnosis tools (applications, AI, digital questionnaires), better informing healthcare professionals about depression detection, helping to develop simplified city care pathways (appointments, referrals), …

Discover how our specialized team can help you improve your patient pathways >

Diagnosis and treatment: Improving the personalization and effectiveness of care

The diagnosis of depression is based on a clinical evaluation conducted by a healthcare professional, often supplemented by the use of standardized grids such as the PHQ-9 (Patient Health Questionnaire-9)¹⁵. In the absence of biomarkers, the identification of the pathology therefore depends heavily on the caregiver’s expertise and the patient’s ability to express their symptoms. This induces significant variability in patient pathways, depending on the professionals encountered and the level of coordination between different stakeholders¹⁶.

This heterogeneity of diagnosis directly impacts care modalities, often marked by a rapid recourse to antidepressants. However, these treatments show uncertain effectiveness: more than one-third of patients do not respond¹⁷, with sometimes a latency of several weeks before action and frequent side effects, which differ depending on the class of antidepressant prescribed (weight gain, sexual disorders, decreased adherence from the first weeks)¹⁸.

If these treatments remain widely prescribed, it is also because they fit within a constrained framework: their accessibility and rapid implementation adapt more easily to the short format of consultations, whereas psychotherapeutic support remains difficult to access (low availability, waiting times, cost). Yet, psychotherapy is recommended for all major depressive episodes¹⁹.

This default care model, centered on medication, favors treatments that are not always suited to each patient’s profile and contributes to insufficient overall effectiveness.

To improve the quality and personalization of diagnosis and treatment, health stakeholders could: support the use of standardized diagnostic tools (e.g., PHQ-9), strengthen coordination between professionals through referral platforms or shared follow-up, promote more personalized care by adapting the choice of treatment and support to the specific needs of each patient, …

Despite advances in recognition, depression remains a poorly identified pathology and unevenly managed. Each stage of the care pathway presents areas for improvement, whether in detection, access to care, or personalization of treatment.

Alcimed supports healthcare stakeholders in transforming the mental health care pathway. This represents an opportunity for impact not only on the medical world and therapeutic innovation but also at a societal level. Do not hesitate to contact our team!

About the author,

Elie, Consultant within Alcimed’s Healthcare team in France

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How to improve the management of depression to address current mental health crisis?

Understanding depression: Definitions and biological origins

Awareness: Overcoming stigma and bridging the lack of reference points on depression

Pre-diagnosis: Facilitating access to specialists

Diagnosis and treatment: Improving the personalization and effectiveness of care

Have a project and want to discuss it?

Tell us about your project!

To go further

What are the challenges in managing neurodevelopmental disorders (NDDs)?

Rare diseases care pathway: a major challenge to harmonize patient management

Anxiety and depression post COVID-19, the need for new therapies