Major depressive disorder has an average lifetime prevalence of about 15 percent, with a twofold greater prevalence in women than men. Age of onset is generally after age 20 and before age 50. Onset after age 50 is associated with a higher incidence of structural brain lesions, including strokes and subcortical white-matter changes (Coffey et al., 1993). While single episodes are not rare, depression is generally considered a chronic, relapsing, and remitting illness. While periods of clinical normality are seen throughout the natural course of the disorder, recurrences occur with higher frequently and with greater intensity if episodes are not treated (Frank and Thase, 1999).

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