Atypical depression. A valid clinical entity?
The history of atypical depression is summarized, and the results of several treatment outcome studies are reviewed. A number of clinical course, family, and biologic variables in patients with atypical depression are investigated, and these patients are compared with patients with other depressive conditions. The Atypical Depression Diagnostic Scale Question Book also is presented.
Available from: Concetta De Pasquale
- "Furthermore, atypical TRD itself largely accounts for the variance in TRD outcome, which is actually " very typical " from a prevalence standpoint, as outlined by the Sequenced Treatment Alternatives to Relieve Depression (STARnD) (Trivedi et al., 2006), with reported rates of 18-19% among depressed outpatients (possibly higher in cases with a history of TRD) and a lower propensity to respond to standard antidepressants, namely the selective serotonin reuptake inhibitors (SSRIs) or their sequenced treatment alternatives (Novick et al., 2005; Stewart et al., 2010). Remarkably, though part of the historical criteria for atypical depression arose from the observation of a fair response to monoamine oxidase inhibitors vs. the tricyclic antidepressants available at the time (Stewart et al., 1993; West and Dally, 1959), because of their poor benefit/risk ratio, modern clinicians tend to use newer antidepressants for all outpatients, regardless of the presence of atypical features, especially upon patient failure to respond to SSRIs (Nierenberg et al., 1998; Schultz, 1999). Such an attitude is exemplified by the spreading use of the serotonin norepinephrine reuptake inhibitor (SNRI) duloxetine even for atypical cases of SSRI-TRD, although this drug displays a negligible efficacy advantage vs. the SSRIs, at least for less severe manifestations of depression, as documented by an 8-week, flexible-dose open-label study carried on 20 MDD patients, including a subset of atypical cases (Papakostas et al., 2007; Shelton et al., 2007). "
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ABSTRACT: The efficacy, safety, and tolerability of combined bupropion versus placebo using duloxetine as active reference drug, in patients with a DSM-IV diagnosis of major depression with atypical features and a history of treatment resistance, were evaluated in this preliminary six-week study. Patients (n=46) had a baseline Hamilton Depression Scale (HAM-D) ≥14 and were randomly assigned to 150/300 mg/day bupropion vs. placebo, which was added to 60 to 120 mg/day duloxetine depending on baseline depression severity. Atypical features of depression were assessed using the additional eight-item module of the Structured Interview Guide for the HAM-D with the Atypical Depression Supplement. By week 6, only five (21.7%) patients receiving duloxetine+placebo vs. six (26.1%) patients on the bupropion combination achieved response. No significant difference in final HAM-D scores between the two groups was observed between those patients achieving response. The presence of a higher number of atypical features significantly predicted non-response, with the relevant binary logistic regression model correctly classifying 17 out 22 (77.3%) of non-responders [Exp(B)=0.294; p=.016] vs. 17 out 23 (73.9%) [Exp(B)=0.353; p=.028] non-responder cases in the “+placebo” and “+bupropion” groups, respectively. In those patients receiving bupropion, treatment-emergent adverse events leading to withdrawal were more common among those receiving lower doses of the combination drug, and no life-threating dangers were noted. Additional studies, including an adequate course of duloxetine trial, are nonetheless aimed to allow a firm conclusion about the usefulness of the combination of duloxetine and bupropion for treatment-resistant cases of major depression with atypical features.
European Neuropsychopharmacology 08/2014; DOI:10.1016/j.euroneuro.2014.04.004 · 4.37 Impact Factor
Available from: Daniela Gremaud-Heitz
- "High interrater reliability has been shown for both interviews  . Additionally the Atypical Depression Diagnostic Scale (ADDS)   was used to examine atypical depression more detailed. The ADDS is a semistructured interview designed to investigate the presence and severity of atypical features during current depressive episodes. "
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ABSTRACT: The core features of borderline personality disorder (BPD) are affective instability, unstable relationships and identity disturbance. Axis I comorbidities are frequent, in particular affective disorders. The concept of atypical depression is complex and often underestimated. The purpose of the study was to investigate the comorbidity of atypical depression in borderline patients regarding anxiety-related psychopathology and interpersonal problems.
Sixty patients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) as well as the Atypical Depression Diagnostic Scale (ADDS). Additionally, patients completed a questionnaire (SCL-90-R, BDI, STAI, STAXI, IIP-C).
Forty-five BPD patients (81.8%) had a comorbid affective disorder of which 15 (27.3%) were diagnosed with an atypical depression. In comparison to patients with major depressive disorder or no comorbid depression, patients with atypical depression showed significant higher scores in psychopathological symptoms regarding anxiety and global severity as well as interpersonal problems.
The presence of atypical depression in borderline patients is correlated with psychopathology, anxiety, and interpersonal problems and seems to be of clinical importance for personalized treatment decisions.
Comprehensive psychiatry 12/2013; 55(3). DOI:10.1016/j.comppsych.2013.11.021 · 2.25 Impact Factor
Available from: J-P Jean-Philippe Lang
- "L'équipe de Columbia étudie dans ces premiers travaux la validité des différents critères diagnostiques et de leur association entres eux comme proposé plus tard par le DSM-IV-TR. Une revue de la littérature réalisée en 1993 par l'équipe de Columbia, propose une première échelle d'évaluation de l'atypicité dans les épisodes dépressifs appelée « The Atypical Depression Diagnostic Scale » . Notons que cette échelle est utilisée dans certaines études présentées ici afin de valider le diagnostic de dépression atypique, tout du moins pour les travaux futurs de l'équipe de Columbia . "
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This paper examines whether atypical depression is still a valid entity as a diagnosis subtype in the light of publications with most recent antidepressants.
First, we present the origins of the diagnosis sub-specification of atypical depression, which is based on a different drug response to tricyclic antidepressants and mono amino oxydase inhibitors. Secondly, we discuss the different definitions that can be found for the terms of atypical depression. We present more specifically the definition of atypical depression as it is described in the DSM-IV, with its most important criterion: mood reactivity. Then we present a review of scientific publications questioning atypical depression validity as a clinical syndrome (based on medline researches). We will see whether this diagnosis is still relevant with the latest drugs used to treat mood disorders. A special focus is made on the link between atypical depression and bipolar disorder, based on Benazzi's work.
Most of publications confirm that atypical depression is a valid syndrome regarding first antidepressants clinical trials. Nevertheless, more studies with the latest antidepressants and atypical antipsychotics are needed to confirm this hypothesis. The link between atypical depression and bipolar disorders seems to be quite strong although it requires further investigations.
There are very few double-blind drug trials focusing on atypical depressions and results need to be confirmed by trials with new drugs. Moreover, we regret that there are no studies including cerebral imagery. More studies are also needed on neurobiology and psychotherapy specificity.
Atypical depression is still a useful concept, because of its specific clinical presentation, evolution and treatments, even if more studies should be done. Atypical depression could also be useful to diagnose more easily some bipolar disorders and should help clinicians to focus more on suicidal risks and addiction evaluation for these patients, considering the mood reactivity and the link with bipolar disorder. To conclude, we propose that atypical depression should still figure in the future DSM-V for these different reasons.
L Encéphale 09/2013; 39(4):258–264. DOI:10.1016/j.encep.2012.08.008 · 0.70 Impact Factor
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