In This Issue

Some benefits of deep brain stimulation for patients with refractory depression emerge more than a year after treatment begins. For 20 patients followed up by Kennedy et al. (p. 502) for 3-6 years, rates of response and remission at the end of year 3 were 60% and 40%, respectively. Reductions in depressive symptoms during the first year were maintained, and physical health and social and emotional functioning continued to improve past year 1. As Hirschfeld notes in his editorial (p. 455), the apparent suicides of two study patients reinforce the seriousness of treatment-resistant depression.

Implementation of the Patient Protection and Affordable Care Act in 2019 is likely to expand insurance coverage to 3.7 million people with severe mental disorders. A 2004-2006 survey showed that the proportion of uninsured individuals was high among those with severe depression or other psychological stress. Garfield et al. (CME, p. 486) estimate that the expanded coverage will increase users of mental health services by 4.5%. Essock and Hogan (p. 449) point out that previous mandates for care led to engagement of master's-level clinician networks, many of which have not fulfilled expectations. Their editorial calls for increased attention to design of more appropriate care systems.