Utilization of psychotherapy, pharmacotherapy, and their combination by individuals with current or residual depression: results from five annual nationally representative German surveys

Depression is a common and burdensome mental disorder affecting more than 320 million people worldwide. Clinical practice guidelines recommend psychotherapy, antidepressant pharmacotherapy, or their combination as the cornerstones of evidence-based treatment. Despite these well-established therapeutic options, a substantial proportion of individuals with depression remain untreated. In Germany, available estimates of the current treatment gap are outdated. The present study therefore aims to examine report the utilization of psychotherapy, antidepressant pharmacotherapy, or their combination among adults in Germany who self-reported a diagnosis of depression. In addition, we explore potential differences in treatment utilization according to sociodemographic characteristics, specifically sex and age. Between 2018 and 2022, annual population-representative surveys were conducted in Germany. A total of N = 3,416 individuals who self-reported having been professionally diagnosed with depression at least once in their lifetime and who indicated current acute or residual symptoms were included in the present analysis. Overall, 63.4% of participants reported using at least one guideline-based treatment for their current depressive episode or residual symptoms. Specifically, 13.5% reported receiving psychotherapy, 26.5% pharmacotherapy, and 23.4% a combination of both. The likelihood of utilizing psychotherapy decreased with age (18-29 years: OR = 1.22, 95% CI = 0.91-1.64; 60-69 years: OR = 0.36, 95% CI = 0.24-0.52), whereas the likelihood of pharmacotherapy use increased with age (18-29 years: OR = 0.74, 95% CI = 0.54-1.01; 60-69 years: OR = 2.46, 95% CI = 1.89-3.23). Although self-reported utilization of guideline-based treatment for depression was higher than previously reported, depression in adulthood likely remains undertreated. These findings highlight the need to strengthen access to evidence-based interventions and to promote long-term treatment adherence and self-management strategies.