Recurrent unipolar depression requires prolonged treatment.

Psychiatric disorder is now recognised as Psychiatric disorder is now recognised as one of the greatest causes of human one of the greatest causes of human suffering. The burden to society of various suffering. The burden to society of various diseases has been quantified recently using diseases has been quantified recently using disability-adjusted life years (DALYs), a disability-adjusted life years (DALYs), a measure that expresses years of life lost to measure that expresses years of life lost to premature death and years lived with a premature death and years lived with a disability of specified severity and duration. disability of specified severity and duration. The burden of mental illness is second only The burden of mental illness is second only to that of cardiovascular conditions in the to that of cardiovascular conditions in the developed world and when DALYs related developed world and when DALYs related to alcohol and drug misuse are included it is to alcohol and drug misuse are included it is the largest single category (Murray & the largest single category (Murray & Lopez, 1997). Unipolar major depression Lopez, 1997). Unipolar major depression currently imposes the second largest burden currently imposes the second largest burden of any individual disorder in the developed of any individual disorder in the developed world and, because of the decline in the world and, because of the decline in the incidence of ischaemic heart disease, may incidence of ischaemic heart disease, may soon be the leading individual illness soon be the leading individual illness category (Murray & Lopez, 1997). Clearly, category (Murray & Lopez, 1997). Clearly, any improvements in the treatment of any improvements in the treatment of unipolar depression would produce great unipolar depression would produce great benefits in the health of the public. benefits in the health of the public. The high disease burden of unipolar The high disease burden of unipolar major depression is understandable when major depression is understandable when one considers the nature of the illness. one considers the nature of the illness. Individual episodes are often prolonged, Individual episodes are often prolonged, there is a high rate of progression to there is a high rate of progression to chronicity and relapse and recurrences are chronicity and relapse and recurrences are frequent. In addition, the illness is asso-frequent. In addition, the illness is associated with pronounced psychosocial and ciated with pronounced psychosocial and physical impairments and a …