Toward a Rational Model of Depression Treatment

Depression is a heterogeneous condition with significant variations in both course and response to treatment. The diverse needs of depressed individuals suggest that treatment should be organized systematically, with multiple efficacious treatment modalities such as psychotherapy and pharmacotherapy available and delivered in a manner and sequence consistent with the best available evidence. Moreover, these systems must be cost-conscious, implementable in regular practice, and accessible to those who require treatment. We term such structures “rational” systems of care. In this chapter, we provide a review of essential components of a rational system, including (1) identifying individuals in need of services, (2) selecting treatment(s), (3) monitoring response and supporting clinical decisions, (4) adapting treatment strategies, (5) maintaining the treatment response, and (6) maximizing access. Case examples of national efforts to implement systems of depression care are provided and discussed, followed by a review of implementation and research issues.