Long-term nature of depression

Many, if not most, people with depression are at high risk to develop a rec urrent and potentially chronic disorder, characterized by deleterious effec ts on vocational, social, and family functioning. Recent evidence also sugg ests that recurrent episodes of severe depression are associated with chang es in brain function that further heighten vulnerability and functional imp airment. The best way to deal with these sobering problems is prevention vi a vigorous treatment of the index episode (to produce complete remission) a nd more routine use of longer term models of prophylactic therapy. After br iefly reviewing the relevant data on epidemiology and natural history, this article focuses on the 4 "arms" of preventative treatment: psychoeducation , pharmacotherapy, adherence, and psychotherapy. Like the modern approach t o treatment of hypertension, a conscientious and integrated approach to pre ventative therapy saves lives and has profoundly beneficial effects for our patients, their loved ones, and society.