We report on the treatment received by 217 patients in the community with a diagnosis of major depressive disorder of at least one month's duration. Only a low proportion of subjects received intensive treatment with antidepressant medication or electroconvulsive therapy, as judged by research standards and current clinical teaching. Specific associations emerge between treatment and several clinical, sociodemographic, and diagnostic variables; however, taken together these variables account for only a small fraction of the variance in treatment received. Even among patient subgroups based on severity and long duration of illness, high proportions did not receive adequate therapeutic trials. Substantial differences are found in treatment across community centers that are not attributable to variation in the clinical characteristics of patients. We conclude that more research is needed to determine how patients and practitioners contribute to this phenomenon of low intensity of somatic treatment.
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