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To the Editor: Dr Olfson and colleagues¹ report a 3-fold increase in population-wide treatment of depression in the United States between 1987 and 1997. The authors present some possible reasons for this increase in their conclusions, specifically the introduction of selective serotonin reuptake inhibitors (SSRIs), aggressive pharmaceutical industry advertising, public health educational efforts, and better available screening instruments.

I wonder if the common denominator here is better diagnosis and treatment of depression in the primary care setting. This would also account for the increase in treatment by physicians that Olfson et al noted. I suspect that referral to psychiatrists has not become appreciably less laden with stigma or more affordable, but rather that the increased treatment is most likely due to nonpsychiatric physicians becoming more willing and adept at detecting and treating depression.

Having said that, I think that the authors' definition of psychotherapy as any "psychotherapy/mental health counseling" may . . . [Full Text of this Article]

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