Depressive disorders are a chronic, recurrent, and severe burden to bo
th patients and their families. Depressive disorders represent a major
national public health problem, ranking within the top 10 most costly
diseases in the United States. In 1990, depressive disorders afflicte
d at least 11 million Americans and cost the U.S. economy an estimated
$44 billion. In addition, affective disorders are associated with inc
reased accident rates, increased rates of substance abuse (especially
alcoholism), increased medical hospitalization, and an increase in som
atic illnesses and outpatient medical utilization. Despite their ranki
ng as a major health problem, depressive disorders are often underdiag
nosed and undertreated. Brief treatment strategies that focus only on
acute episodes ale often ineffective and result in chronic impairment,
impairing performance at work and socially. Inadequate treatment incr
eases costs, suffering, and lost productivity. Recent data suggest tha
t effective treatment of depression requires long-term, skillful follo
w-up and active pharmacotherapy.