Role of serotonin and noradrenaline in social dysfunction: a review of data on reboxetine and the Social Adaptation Self-evaluation Scale (SASS)

Social impairment is a common feature of depressive illness, often causing substantial and clinically meaningful dysfunction. Although the depressive symptoms and social impairment are linked, the naturalistic course and resp onse to treatment of these two aspects of depression do not necessarily cor relate. A variety of self-report and clinician-administered assessment scal es which are specific for the measurement of social functioning and have go od psychometric properties have been developed in the past 40 years. The mo st recent of these instruments is the Social Adaptation Self-evaluation Sca le (SASS), a 21-item scale designed in 1989 to assess patient response to a ntidepressant treatment. SASS was used in two clinical trials comparing reb oxetine, the new selective noradrenaline reuptake inhibitor (selective NRI) , with fluoxetine. While no difference in efficacy was detectable by tradit ional assessments of symptoms, reboxetine proved to be significantly more e ffective than fluoxetine in improving social functioning in patients with d epression. Reboxetine was also more effective than fluoxetine in rectifying social functioning in the subset of patients who remitted from an episode of major depression. Specifically, reboxetine improved patient motivation, energy and self-perception. These results indicate that antidepressant ther apy can achieve more than symptom relief in depression. It is speculated th at there may be a difference in the roles played by serotonin and noradrena line in social functioning. (C) 2001 Elsevier Science Inc. All rights reser ved.