Objective: To consider why the burden of depression persists.

Method: The epidemiology and disability associated with depression were reviewed to consider whether depression persists because: the causes are overwhelming, prevention is ineffective, the disease is difficult to detect or diagnose, the condition remits and recurs, treatments do not work, individuals do not seek treatment, or effective care is not provided when they do seek it.

Results: The first 5 possibilities were not considered significant reasons for the persistence of the burden.

Conclusion: The burden persists because individuals do not seek treatment for their depression when they relapse and effective proactive treatment is not always provided when they do seek it.