Depression should be managed like a chronic disease

Depression is often referred to as the common cold of psychiatry. But this analogy is wrong: although common, most depressive disorders are not mild and self limiting. It is time that we treated depression as the chronic disease that it is.

The World Bank ranks unipolar depression as the number one contributor to the global burden of disease in adults aged 19-45 in the developed world.1 Up to 15% of adults may experience clinical depression, 20% will not recover fully from the index episode, and 70-80% of those achieving remission succumb to at least one recurrence. Eighty per cent of individuals with milder persistent symptoms or dysthymia will develop a major depressive episode, and 15% of all patients with depression will eventually commit suicide.

Ninety per cent of cases of depression are treated in primary care, where depression is the third most common reason for consultation. Two articles in this issue hypothesise that screening for depression cases would not improve patient outcomes (p 1027),2 whereas increased access to therapy would (p 1030).3 The …