Social aspects of treatment of depression

Epidemiological studies of depression have shown a consistent, clinical syndrome across different societies, most of the symptoms being included in DSM-III-R. It is an illness associated with considerable impairment of social function, and in DSM-IV social or occupational dysfunction is included as a criterion for diagnosis. There is also an increased suicide risk which has to be taken into account when selecting treatment. Most depression is treated in general practice, where treatment has tended to be of short duration. The usefulness of tricyclic antidepressants in limited by their toxicity in overdose and their unwanted side effects, which lead to the overuse of health care facilities, reduce compliance, and have social and quality of life consequences particularly in long-term treatment. On these measures the selective serotonin reuptake inhibitors offer a preferred choice of treatment in view of their improved safety and tolerability profile.