The undertreatment of depression

In spite of considerable progress in the establishment of physical and psychological treatments for major depression in clinical trials, little is known of the impact of treatment on the prevalence and course of depression in the population. Improved methods for assessing need for care have not yet been applied systematically to such a population. One hundred and thirty men and women attending psychiatric hospitals with depressive disorders were interviewed at the time of their initial contact. After a mean 4-month interval, 119 were reassessed in order to determine the extent to which potentially effective treatments were being fully deployed in those who had not made a complete recovery. Half had made a good recovery. At least 78% of those remaining at threshold level or above apparently had not been offered alternative, potentially effective physical or psychosocial treatment, and were therefore rated as having unmet need. Older male patients were less likely to have unmet need. This study thus raises doubts about the effectiveness of routine clinical management of depression. However, we will remain uncertain of how far the routine falls below the ideal until systematic needs for care procedures (Brewin et al. 1987) are applied prospectively to depressed populations.