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Recent transnational epidemiological surveys have not confirmed that medicalisation of sadness is a general phenomenon in the community.3 Rather, a substantial proportion of individuals with depression, even of severe degree, do not receive drug or other professional treatments. This is especially so in developing countries (including Beijing and Shanghai in China), where typically less than 10% of people with mood disorders will ever receive any form of professional treatment.4
The epidemiological meaning of a “case” of depression (such as mild major depressive episode) may have little to do with whether the affected person needs psychiatric evaluation or drug treatment, or both. This is not unlike increasingly lenient public health definitions of physical conditions such as obesity or serum cholesterol concentrations in the general population. In the spirit of early intervention, psychosocial intervention or a change in lifestyle may work better than drugs in alleviating such mild metabolic disturbances.
The real problem for the increasing diagnosis of depression is the poor access to quality psychosocial interventions such as cognitive therapy not only in developing countries but also in much of the developed West. This is despite a strong base of evidence showing that such interventions are at least as effective as drugs in treating and preventing depression. In many parts of the world clinical psychology does not exist.
Competing interests: None declared.