Depression Treatment-Prevalence Paradox

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Depression is the main reason why people miss work and social activities. Unfortunately, therapies for depression are somewhat recent creations, with most of them being antidepressant drugs and psychotherapies invented in the 20th century.

Since the early 1980s, depression therapies have evolved and become more available, primarily due to the advancement of selective serotonin reuptake inhibitors (SSRIs).

At the same time, there is still a stigma associated with depression. Getting therapy has declined over the last few decades, a massive change in attitude because of the ’90s, from the direct-to-consumer advertisement of antidepressants started.

You could imagine that these changes may have helped reduce the number of people with depression. But it has not at all.

A new study published in the Journal of Clinical Psychology looked at the possible causes of the phenomenon the researchers named the “treatment-prevalence paradox” (TPP).

These findings raise questions about the effectiveness of therapies for depression, which affects more than 5% worldwide.

The Depression Treatment-Prevalence Paradox

Scientists define TPP as the lack of a significant decline in depression when there are better depression therapies that have become more widely available.

In the study, depression is defined as major depressive disorder (MDD). At the same time, the term prevalence is expressed as the percentage of correctly diagnosed with depression at any time, usually about 30 days before the diagnosis.

To research the causes of TPP, the researchers began by figuring out if one of the two situations is factual.

The first situation assumes that improved therapies have reduced the prevalence. However, the reduction was covered by increased false-positive diagnoses or people with a substantial rise in depression.

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The second situation assumes the prevalence hasn’t gone down and that one or a combination of the following explain TPP:

  • therapies are less long-term than suggested
  • therapies are less effective
  • studies do not generalize well to the actual settings of the natural world
  • population-level therapies efficiency differs considerably for reoccurring versus non-recurrent cases
  • a medicine may have both beneficial and harmful side effects

The researchers eventually ruled out the first situation. Though, the destigmatization of mental illness might have made some more willing to get therapy or possibly made them less sensitive to suffering, like how they decipher normal levels of pain as signals of depression.

Nevertheless, in terms of the truthfulness of MDD, the researchers noted that “it is doubtful that a noteworthy drift in case-definition has happened in epidemiological studies having controlled interviews, regular categorization, and well-trained therapists conducting the interview.”

Therapies are Less Effective

That leaves the second situation: the prevalence of depression has not decreased. So, why is this?

The study revealed various reasons for the most responsible for TPP.

Generally, the researchers determined that the effectiveness of depression therapies in controlled studies is misjudged due to numerous reasons, comprising publication bias, citation bias, outcome reporting favouritism, and other methodological interests.

This is usually for acute depression therapies and longer-term care therapies.

The study also discovered that depression therapies — even those tested under controlled, randomized trials — tend not to oversimplify real situations and settings.

The scientists concluded on the more theoretical side by writing the likelihood that some therapies today may have adverse side effects that doctors have yet to find and may be triggering a part of the TPP.


Dean Mathers


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