The Wisdom of Crowds (Vox Populi) and Antidepressant Use

What is it about?

The rate of use of antidepressant medications is controversial. It is agreed that there has been a large increase in the use of these medications, but there is little agreement on whether this is a bad or good thing. Some authors claim that the increase represents over-treatment whereas others are more concerned with under treatment. At some level the decision to take these medications and more importantly whether to continue taking them depends on many individual factors and are decisions that are usually made on an individual level based on discussions between patients and professionals. The net effect of perceived beneficial and adverse effects and the natural history of depressive disorders has apparently (at least in Canada) led to a "steady state" rate of use of 4-5%. This may represent an intelligent "crowd" decision about the optimal rate of use (a concept popularized by James Surowiecki), which has eluded expert consensus.

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Why is it important?

Given the current state of therapeutics for depression, a rate of 4-5% may be an appropriate target for antidepressant use in the general population. This idea counter-balances (or at least provides a different perspective on) the frequent assertions of under-treatment or over-treatment - and the sometimes acrimonious debate about whether policy to be encouraging more treatment, or less.