Unipolar depression in adults and initial treatment: General principles and prognosis
- Gregory Simon, MD, MPH
Gregory Simon, MD, MPH
- Group Health Research Institute
- University of Washington Department of Psychiatry and Behaviorial Sciences
- Paul Ciechanowski, MD
Paul Ciechanowski, MD
- Clinical Associate Professor of Psychiatry
- University of Washington School of Medicine
Unipolar depression is highly prevalent and disabling. Community surveys in 14 countries have estimated that the lifetime prevalence of unipolar depressive disorders is 12 percent , and the World Health Organization ranks unipolar major depression as the 11th greatest cause of disability and mortality in the world, among 291 diseases and causes of injury . In the United States, major depression ranks second among all diseases and injuries as a cause of disability, and dysthymia as the 20th .
In addition, major depression is highly recurrent. Following recovery from one episode, the estimated rate of recurrence over two years is greater than 40 percent; after two episodes, the risk of recurrence within five years is approximately 75 percent .
This topic reviews the general principles and prognosis for the initial treatment of depression. Choosing a therapy for the initial treatment of depression and the general evidence of efficacy of standard therapies are discussed separately, as are the evidence for therapies that are not typically used, and the evidence for standard therapies that are used for initially treating depression in primary care patients and in patients with general medical illnesses. Continuation and maintenance treatment of major depression, the treatment of resistant depression and refractory depression, and the clinical manifestations and diagnosis of depression are also discussed elsewhere.
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- GENERAL PRINCIPLES
- Screening and diagnosis
- Ruling out bipolar depression
- Suicidal and homicidal ideation and behavior
- Reluctance to start treatment
- Peer support
- PATIENT EDUCATION
- Discussing the diagnosis
- Adherence to antidepressants
- INFORMATION FOR PATIENTS