[More treatment but no less depression. An uncomfortable paradox].

Our analysis suggest that there is little evidence that false positives or first incidence have increased as a result of error or fact but rather strong evidence that (a) the published literature overestimates treatment efficacy, that (b) treatments are considerably less effective as deployed in ‘real world’ settings, and (c) that treatment impact differs substantially for chronic-recurrent cases relative to non-recurrent cases. Collectively, these three explanations probably account for most of the paradox. Further exploration of counterproductive effects of treatment is critical. Significant prevalence reduction requires not only better treatment but foremost long-term structurally funded prevention targeting powerful determinants.