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Treatment for Depression After Unsatisfactory Response to SSRIs

Depression is a complex mental illness associated with disability and reduced quality of life for the person with depression, as well as substantial societal burden. Major depressive disorder (MDD) is the second leading medical cause of long-term disability, the fourth leading cause of global burden of disease, and is predicted to become the second highest cause of disability by 2020.1,2 Depression exerts a negative impact on physical health; it reduces adherence to medical treatment,3 reduces participation in preventive activities,4 and increases the likelihood of risk factors such as obesity,5 smoking,6 and sedentary lifestyles.7 MDD may be associated with immune dysfunction8-11 and cardiovascular disease,12-15 endocrine and neurological diseases, and a general increase in chronic disease incidence.16 Mortality rates are high: approximately 4 percent of adults with a mood disorder die by their own hand, and about two-thirds of suicides are preceded by depression.17 In adolescents, untreated depression results in significant impairment in school performance, interpersonal relationships, risk of suicidal behavior and completion of suicide, risk of early pregnancy, occupational maladjustment, and impaired social and family functioning.18 Effective Health Care Program