Focus on social functioning in depression

Depressive disorders represent a significant global health burden. By the year 2020 the contribution of psychiatric and neurological conditions to the global burden of disease is predicted to reach 15%. Despite this, depression is frequently unrecognized and undertreated; most depressed people do not seek treatment for their depression, and of those who do, most do not receive adequate treatment. Depression is a debilitating condition and the effects of the illness extend beyond the classically defined symptoms to almost every facet of an individual's life, including their social interactions; and even beyond the individual, to close relatives. The treatment of impaired social functioning has not been widely adopted as a therapeutic principle in depression, although it is recognized as an important part of the treatment of schizophrenia. However, depressed individuals experience more functional impairment than patients with other chronic medical conditions such as diabetes and hypertension. Early studies have suggested that antidepressants, in addition to improving the core symptoms of depression, are effective in the treatment of impaired social functioning; but few studies have directly compared different classes of antidepressants. This paper seeks to raise awareness of the key issues relating to the treatment of impaired social functioning in depression and to provide a basis for wider discussion of the topic prior to the establishment of treatment guidelines.