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Major depressive disorder (MDD) is a commonly occurring
(Ferrari et al., 2013), seriously impairing (Kessler,
2012), and woefully undertreated (Thornicroft et al., 2017)
disorder that is rated by the Global Burden of Disease
(GBD) Study as one of the more burdensome diseases in
the world (GBD 2015 Disease and Injury Incidence and
Prevalence Collaborators, 2016). Less than one-third of
MDD patients in clinical trials remit in response to a first
full course of treatment of either antidepressant medication
(ADM) or psychological therapy (Cuijpers, van
Straten, van Oppen, & Andersson, 2008). The remission
rate is even lower in routine care (e.g., Garrison, Angstman,
O’Connor, Williams, & Lineberry, 2016; Sacks, Greene,
Hibbard, & Overton, 2014; Vuorilehto, Melartin, Riihimaki,
& Isometsa, 2016). Such therapeutic failures are intolerable
to many patients, especially those struggling with
hopelessness, as indicated by the fact that fully half of the
121 daily suicides in the United States occur among
individuals who were treated for a mental disorder in the
prior 12 months (Ahmedani et al., 2014) and the fact that
MDD was the most common treated mental disorder
among these suicide decedents (Bertolote, Fleischmann,
De Leo, & Wasserman, 2004).
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