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Roger S. McIntyre

and Jay Nathanson

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date: 22 January 2020

This introductory chapter focuses on major depressive disorder (MDD. The causes of MDD are multifactorial, and include a modest genetic underpinning as well as exposure to distal (e.g., childhood trauma) and proximal psychosocial stressors. During the past decade, there has been a substantial increase in the proportion of North Americans who have received pharmacologic and non-pharmacologic treatments for MDD. This upward trajectory is related to a significant increase in large population- and clinical-based programmes to promote the awareness of mood disorders. It is frequently postulated that severe depression is a distinct subphenotype of MDD. It is not known, however, if severe depression represents a distinct subtype of MDD or whether it is a transient exacerbation of a chronic disease. This title sketches a composite of severe depression, with a particular emphasis on definitions, operational criteria, phenomenology, course of illness, neurobiology, and treatment. The encompassing aim of this initiative is to provide multi-disciplinary practitioners and allied health care professionals with a contemporary synopsis and framework of severe depression in order to more effectively diagnose and treat individuals who suffer from this condition.

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