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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 the lesion. An alternative hypothesis is that antidepressants act upon intact monoamine systems to produce functional changes that are not necessarily a reversal of the initial cause. If this is the case, one would expect that currently available classes of antidepressants would have overlapping spectra of therapeutic effects and that, while all may be effective in the majority of patients, some will be more useful according to individual needs. To date, the assessment of recovery from depression, using scales such as the Hamilton Rating Scale for Depression, has been physician centred. Such assessments leave open the possibility that patients may not have recovered in terms of their social adaptation and that, accordingly, the patients themselves and their relatives may not perceive them as having recovered. Findings of differences between antidepressants on the Social Adaptation Self-evaluation Scale highlight the importance of patient perception of treatment efficacy. These differences may indicate differences in efficacy not detected by conventional instruments, differences in tolerability, differences in the speed of onset of antidepressant activity, or differences in the behavioural profile produced by different classes of antidepressants.