A DIALOGUE

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Like many other areas of medicine, psychiatry currently faces the challenge of ensuring optimal care and enhancingquality of life for patients while working within the financial constraints introduced by trying to balancecompeting needs among different sectors of the population. This challenge is particularly salient in the treatment ofdepression in a managed care setting. As an issue that demands simultaneous consideration from clinical, economic,social, and ethical perspectives, this topic raises difficult questions with regard to deciding the psychiatrist’s role as provider and allocator, determining who should assume the burden of risk, and balancing efficacy and effectivenessof different treatments, to name just a few.