Major Depressive Disorder (MDD) represents an enormous mental health challenge. In the National Comorbidity Survey Replication (NCS-R; Kessler et al., 2005), MDD had the highest lifetime and 12-month prevalence (17% and 7%, respectively) estimates of 14 major psychiatric disorders. According to a recent study, MDD affects over 13 million individuals per year in the United States (Kessler et al., 2003). Similarly, according to a recently released World Health Organization study of 245,000 individuals in sixty nations, MDD is more damaging to everyday health than chronic diseases such as angina, arthritis, asthma and diabetes (Moussavi et al., 2007). An often-cited estimate places the monetary cost in excess of $43 billion a year in treatment and lost productivity—a toll slightly larger than the cost of heart disease (Greenberg et al., 1993). A recent study estimated the cost of lost work productivity at $44 billion a year (Stewart et al., 2003). Mintz et al. (1992) found that a disproportionate number of depressed individuals were unemployed (11%) or experienced profound impairment on the job (44%). Kessler and Walters (1998) projected that individuals between 15 and 24 years, who have previously experienced at least one episode of MDD, will experience over 150 million impaired workdays due to their depression. Similarly, in a large epidemiological sample (N = 18,571), Johnson et al. (1992) found that individuals with a mood disorder reported increased use of medical services or the emergency department for emotional problems, increased use of psychoactive medications, impaired physical and emotional health, lost time at work, and increased rates of attempted suicide. Finally, the greatest predictor of having major depression is whether one has had MDD previously, which argues for a chronic disease care perspective. "Approximately 50%-60% of individuals with MDD, Single Episode, can be expected to have a second episode. Individuals who have had two episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth" (APA, 1994, pp. 341-342). The risk of MDD becoming a chronic problem increases substantially with each additional episode (Keller et al., 1986). Despite successful medication and psychotherapies, fewer than half of patients achieve remission (Casacalenda et al., 2002) and relapse is more likely in individuals who do not fully recover (Jarrett et al., 2001; Thase et al., 1992).