Depression is an eminently treatable disorder that responds to psychotherapy or medications; the efficacy of each has been established in hundreds of controlled trials. Nonetheless, the prevalence of depression has increased in recent years despite the existence of efficacious treatments—a phenomenon known as the treatment–prevalence paradox. We consider several possible explanations for this paradox, which range from a misunderstanding of the very nature of depression, inflated efficacy of the established treatments, and a lack of access to efficacious delivery of treatments. We find support for each of these possible explanations but especially the notion that large segments of the population lack access to efficacious treatments that are implemented as intended. We conclude by describing the potential of using lay therapists and digital technologies to overcome this lack of access and to reach historically underserved populations and simultaneously guarantee the quality of the interventions delivered.

中文翻译：

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患病率随着治疗的改善而增加：抑郁症治疗-患病率悖论的进化观点


抑郁症是一种明显可治疗的疾病，对心理治疗或药物有反应;每种药物的疗效已在数百项对照试验中得到证实。尽管如此，尽管存在有效的治疗方法，但近年来抑郁症的患病率有所增加——这种现象被称为治疗-患病率悖论。我们考虑了对这个悖论的几种可能的解释，包括对抑郁症本质的误解、既定治疗的有效性夸大以及缺乏有效的治疗途径。我们找到了对这些可能解释中的每一种的支持，尤其是很大一部分人口无法获得按预期实施的有效治疗的观点。最后，我们描述了使用非专业治疗师和数字技术来克服这种缺乏机会的潜力，以接触历史上服务不足的人群，同时保证所提供的干预措施的质量。