Depression is common in primary care but is sub-optimally managed, especially in low-income individuals. In this study, we compared the effectiveness of a stepped-care programme with usual care in primary-care management of depression in low-income women in Chile. The stepped-care was a 3-month, multicomponent intervention led by a non-medical health worker, which included a psychoeducational group intervention, structured and systematic follow-up, and drug treatment for patients with severe depression. A randomised controlled trial was carried out in 240 female primary-care patients with major depression, the primary outcome measure was the Hamilton depression rating scale (HDRS) administered at baseline and at 3 and 6 months after randomisation, and data was analysed on an intention-to-treat basis. There was a substantial between-group difference in all outcome measures in favour of the stepped-care programme. At 6-months’ follow-up, 70% of the stepped-care compared with 30% of the usual-care group had recovered. Despite few resources and marked deprivation, women with major depression responded well to a structured, stepped-care treatment programme. Socially disadvantaged people might gain the most from systematic improvements in treatment of depression. This programme has been adapted and tested in several countries including India, Lebanon, Zimbabwe, Nigeria, Guatemala, and others.