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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 have been too nonspecific. Almost any patient I treat with an antidepressant also receives "psychotherapy" by this definition, as I discuss what depression is, what it is not, and how the medication may be useful. However, I would not consider this psychotherapy in the strict sense. That is, I am not attempting to ameliorate the patient's symptoms via our discussions alone. It may be that such a wide definition artificially inflates the measured rate of psychotherapy in the population, specifically the high rate of combined pharmacotherapy and psychotherapy, rather than denoting a true increase in combination therapy.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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