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Purpose – To examine the influence of changing diagnostic tools and the pharmaceutical and health insurance industries' practices on perceptions of depression prevalence in the late 20th and early 21st centuries.

Approach – This is a general review of the sociohistorical shifts in depression diagnosis and pharmaceutical and health insurance industry practices during this time period as they impact professional and lay perceptions of changes in depression prevalence.

Findings – Shifts in the definition of depression to an increasingly medically oriented, social context-free definition along with the interaction of the pharmaceutical industry, health care, and health insurance industries in the U.S. system of mental health care have become major organizers of professional and lay perceptions of the nature of depression, its treatment, and prevalence. These sociohistorical and economic influences need to be factored into debates on depression prevalence.

Contribution of paper to the field – This chapter provides an introductory-level synthesis of basic psychiatric epidemiology concepts and social science critiques of professional and lay perceptions of depression prevalence as “epidemic.”