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Affective illness affects 11 percent of the adult American population every year and nearly 20 percent at some point during their lifetime. The yearly prevalence breaks down into 10.33 percent for major depression, 2.5 percent for dysthymia, and 11.3 percent for all affective illness (Kessler et al., 1994). The yearly cost of depressive illness is $43.7 billion. Of this total, $12.4 billion is in direct costs for the treatment of depression, including inpatient and outpatient psychiatric services, rehabilitation, and medications. The indirect costs, $31.3 billion, are fully three-fourths of the total and include $7.5 billion from earnings lost due to suicide, $11.7 billion due to absenteeism from work, and $12.1 billion from a loss of productive capacity (Greenberg et al., 1993). One study has found that patients with major depression have a 4.78 greater risk of disability and patients with minor depression have a 1.55 greater risk of disability than those without illness (Broadhead et al., 1990). In addition, patients with depression incur nearly double the medical costs of those without (Simon et al., 1995) and are associated with as much or more functional disability than hypertension, diabetes, advanced coronary artery disease, angina, back problems, arthritis, pulmonary disease, and gastrointestinal disease (Wells et al., 1989). Major depression complicates very seriously the course of medical illness and is associated with a fivefold increase of mortality in patients with acute myocardial