The Persistent Case of Major Depression: An Argument for Long-Term Treatment

According to psychotherapy outcome literature, treatments for major depressive disorder (MDD) yield impressive results. Study after study demonstrates the efficacy of brief, evidence-based interventions for depressed individuals. Nevertheless, MDD continues to exact a devastating toll on modern society. The World Health Organization has identified it as the leading cause of disability worldwide. This reality is surprising given the implications from the academic literature. A historical analysis of MDD treatment suggests that most people with MDD experienced complete remission and enhanced outcomes when long-term, psychodynamically influenced treatments prevailed. An analysis of the system that perpetuates the brief intervention model for MDD, managed care, is discussed. This analysis is followed by a case study that illustrates the harm managed care can do to patients with MDD who are not permitted treatment of longer duration. Implications and recommendations for psychologists to intervene at the micro and macro levels are discussed.