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The Clinical Course of Unipolar Major Depressive Disorders

Lewis L. Judd, MD
Arch Gen Psychiatry. 1997;54(11):989-991. doi:10.1001/archpsyc.1997.01830230015002.
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A FUNDAMENTAL paradigmatic shift is occurring in the understanding of unipolar major depressive disorders (MDD) among the general public, by many public health experts, and by the practicing psychiatric community. Most people in our society no longer view depression as a mysterious sickness of spirit or emotional weakness, but rather as a disease of the brain and an important health problem.1 International public health experts acknowledge the high prevalence of unipolar MDD2 combined with the pervasive human misery and impairment associated with it, and have identified this disease in 1990 as the fourth-ranked cause of disability and premature death worldwide.3 In parallel, the treatment of unipolar MDD has evolved from incarceration, exorcism, and prayer to classic psychoanalysis, and now in the modern era to treatment with empirically proven, effective antidepressant medications and depression-specific brief psychotherapies. Meta-analyses of 6 standardized treatment studies by Thase et al4 have


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