Social inhibition and treatment-resistant depression

Background A personality trait of introversion/social inhibition is increasingly recognized as relevant to the phenomenology and course of depression. We sought to examine the relationship between social inhibition and treatment resistance in depressed patients. Method Data on depression history and severity, self-reported social inhibition and social support, anxiety disorders, treatments trialled and psychiatrist-rated 'treatment resistance' were collected from a sample of 177 depressed patients referred to a tertiary referral Mood Disorders Unit. Results Depressed patients in the 'high' social inhibition group had significantly higher psychiatrist-rated levels of 'treatment resistance', lower perceived social support and had higher rates of social phobia preceding their depression. Conclusion Clinicians managing difficult-to-treat depression should remain aware of the potential role of high social inhibition and low perceived social support in maintaining depression. Further, clinicians should consider the possibility of primary social phobia, as failure to provide specific treatments may be one of the many contributors to the overall category of 'treatment-resistant depression'. Copyright (C) 2007 John Wiley & Sons, Ltd.