[Undertreatment of depression; causes and recommendations]

Abstract

Efficacious forms of treatment for depression are available, but too many people suffering from depression are either treated inadequately or not at all. This undertreatment may play a role in the failure to reduce in the prevalence of depression. Possible causes of undertreatment include delayed help-seeking, delayed treatment, non-compliance, mediocre self-care and inappropriate treatment. Furthermore, the treatment culture is insufficiently population-based and proactive, and the chronic-recurrent nature of many depressions is too often neglected. Both the content and organisation of mental health care, in primary care and speciality services alike, should explicitly target reduction of the prevalence of depression in the population, in particular by trying to narrow the gap between the 'efficacy' and 'effectiveness' of treatment modalities. Important elements in this approach include 'individualized stepped care' models, implementation of optimal care by means of care programs, redefinition of the roles of care-provider and patient (greater emphasis on partnership) and abolition of the distinction between somatic health care and mental health care.