Long-term nature of depression.

Many, if not most, people with depression are at high risk to develop a recurrent and potentially chronic disorder, characterized by deleterious effects on vocational, social, and family functioning. Recent evidence also suggests that recurrent episodes of severe depression are associated with changes in brain function that further heighten vulnerability and functional impairment. The best way to deal with these sobering problems is prevention via vigorous treatment of the index episode (to produce complete remission) and more routine use of longer term models of prophylactic therapy. After briefly 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 to treatment of hypertension, a conscientious and integrated approach to preventative therapy saves lives and has profoundly beneficial effects for our patients, their loved ones, and society.