THE ENHANCEMENT OF SOCIAL FUNCTIONING AS A THERAPEUTIC PRINCIPLE IN THE MANAGEMENT OF DEPRESSION

It has long been considered that depression is a biochemical disorder resulting from dysfunction of monoamine systems in the brain and that antidepressants act upon these systems as 'magic bullets' to correct t he lesion. An alternative hypothesis is that antidepressants act upon intact monoamine systems to produce functional changes that are not ne cessarily a reversal of the initial cause. If this is the case, one wo uld expect that currently available classes of antidepressants would h ave overlapping spectra of therapeutic effects and that, while all may be effective in the majority of patients, some will be more useful ac cording to individual needs. To date, the assessment of recovery from depression, using scales such as the Hamilton Rating Scale for Depress ion, has been physician centred. Such assessments leave open the possi bility that patients may not have recovered in terms of their social a daptation and that, accordingly, the patients themselves and their rel atives may not perceive them as having recovered. Findings of differen ces between antidepressants on the Social Adaptation Self-evaluation S cale highlight the importance of patient perception of treatment effic acy. These differences may indicate differences in efficacy not detect ed by conventional instruments, differences in tolerability, differenc es in the speed of onset of antidepressant activity, or differences in the behavioural profile produced by different classes of antidepressa nts.