This intervention could be used with or as a potential alternative to health-worker-led interventions, and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor populations.

A little over a year ago, The Lancet published a Series of five articles on Global Mental Health that documented the current evidence for global mental health, with a focus on low-income and middle-income countries.1–5 The final paper in the Series made a call to scale up evidence-based packages of services for people with mental disorders with a commitment to the protection of human rights.6 The Series and the call to action that concluded it has received support from leaders in world health (panel 1).

The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment.

We review the evidence on effectiveness of interventions for the treatment and prevention of selected mental disorders in low-income and middle-income countries. Depression can be treated effectively in such countries with low-cost antidepressants or with psychological interventions (such as cognitive-behaviour therapy and interpersonal therapies). Stepped-care and collaborative models provide a framework for integration of drug and psychological treatments and help to improve rates of adherence to treatment.

Depression produces the greatest decrement in health compared with the chronic diseases angina, arthritis, asthma, and diabetes. The comorbid state of depression incrementally worsens health compared with depression alone, with any of the chronic diseases alone, and with any combination of chronic diseases without depression. These results indicate the urgency of addressing depression as a public-health priority to reduce disease burden and disability, and to improve the overall health of populations.

We would like to express our concern that the publishers of The Lancet, Reed Elsevier, are continuing to promote the use of arms by hosting arms trade fairs. The recent Shooting, Hunting, and Outdoor Trade (SHOT) Show1 hosted by Reed Exhibitions was devoted to the glorification of guns; shortly the company is to host an arms fair to the Middle East at a time when the region is the focus of international tension. In the past, manufacturers of cluster bombs have been allowed to participate in such events2 despite the indiscriminate effect of cluster bombs on civilian and military populations.

Affordable antidepressants such as fluoxetine should be the treatment of choice for common mental disorders in general health-care settings in India, since they are associated with improved clinical and economic outcomes, especially in the short term.