Lancet-World Psychiatric Commission Calls for Staged-Approach to Depression Care

New recommendations from a Lancet and World Psychiatric Association commission on depression call, in part, for prioritizing a personalized, staged approach to depression care. The current system of classifying people as either having clinical depression or not, they advised, is too simplistic for a complex condition that varies in signs, symptoms, severity, and duration across cultures and life course.

“No two individuals share the exact life story and constitution, which ultimately leads to a unique experience of depression and different needs for help, support, and treatment,” said commission co-chair Vikram Patel, PhD, from Harvard Medical School. “Similar to cancer care, the staged approach looks at depression along a continuum—from wellness, to temporary distress, to an actual depressive disorder—and provides a framework for recommending proportional interventions from the earliest point in the illness.

Specifically, the commission recommends a personalized, staged approach to depression care that takes into account the chronology and intensity of depressive symptoms and tailors interventions to the specific needs of the person and the severity of the condition. Treatment options can range from self-help and lifestyle changes to psychological therapies and antidepressants to more intensive treatments, such as electroconvulsive therapy for severe, refractory depression.

RELATED: Greg Mattingly, MD, on Unmet Needs in the Treatment of Depression

The commission also proposes the adoption of collaborative care strategies to scale up evidence-based depression interventions in routine care. Community health workers, lay counselors, and other widely available, low-cost nonspecialists would help address the shortage of skilled behavioral health providers as well as ease financial barriers to care, they maintain. While low-income countries would benefit most from such an approach, the recommendation offers universal benefit, the commission pointed out, because depression care is inadequate everywhere.

“Depression is a global health crisis that demands responses at multiple levels. This commission offers an important opportunity for united action to transform approaches to mental health care and prevention globally,” said commission chair Helen Herrman MD, from Orygen, the National Center for Excellence in Youth Mental Health and the University of Melbourne, Australia.

The commission’s recommendations, published online in The Lancet, were written by 25 experts from 11 countries and were advised by people with experience of depression.

—Jolynn Tumolo


Herrman H, Patel V, Kieling C, et al. Time for united action on depression: a Lancet–World Psychiatric Association Commission. The Lancet. Published online February 15, 2022.

THE LANCET: Overlooked and underfunded—experts call for united action to reduce the global burden of depression. News release. The Lancet; February 15, 2022. Accessed February 18, 2022.