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Unipolar major depression in adults: Choosing initial treatment

Gregory Simon, MD, MPH
Paul Ciechanowski, MD
Section Editor
Peter P Roy-Byrne, MD
Deputy Editor
David Solomon, MD


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 [1], and the World Health Organization ranks unipolar major depression as the 11th greatest cause of disability and mortality in the world [2]. In the United States, major depression ranks second among all diseases and injuries as a cause of disability, and persistent depressive disorder (dysthymia) ranks 20th [3].

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 [4].

This topic reviews the choice of therapy for the initial treatment of depression. Other aspects of the initial treatment of depression are discussed separately, as are continuation and maintenance treatment of major depression, the treatment of resistant depression, and the clinical manifestations and diagnosis of depression.

(See "Unipolar depression in adults and initial treatment: General principles and prognosis".)

(See "Unipolar depression in adult primary care patients and general medical illness: Evidence for the efficacy of initial treatments".)


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