Atypical depression. A valid clinical entity?
ABSTRACT 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.
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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; DOI:10.1016/j.comppsych.2013.11.021 · 2.26 Impact Factor
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ABSTRACT: Objective This paper examines whether atypical depression is still a valid entity as a diagnosis subtype in the light of publications with most recent antidepressants. Method 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. Results 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. Discussion 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. Conclusion 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 · 0.60 Impact Factor
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ABSTRACT: For several decades, researchers have sought to fully understand the nature of the relationship between depression and weight. To date, the research in this area has yielded highly inconsistent results, with some identifying null (Crumpton, Wine, & Groot, 1966; Moore, Stunkard, & Srole, 1962), positive (R. E. Roberts, Kaplan, Shema, & Strawbridge, 2000), negative (Silverstone, 1968; Simon, 1963) and gender specific relationships (DiPietro, Anda, Williamson, & Stunkard, 1992; Istvan, Savela, & Weidner, 1992; Onyike, Crum, Lee, Lyketsos, & Eaton, 2003). The author suggests that these inconsistencies can be explained by the use of measures of depression used which do not differentiate between various subtypes of depression associated with divergent somatic symptoms; including atypical depression (AD) and melancholic depression (MD). Adolescence may be an important intervention point to avert adult obesity and identification of subtypes may identify those at greatest risk. Yet, the characteristics of depression subtypes among adolescents are unknown. In order to identify subtypes of depression among adolescents that are differentially associated with weight, Latent Class Analysis (LCA) was conducted and resulting classes were tested for associations with weight. Six latent classes were identified. Four were uniquely associated with somatic symptoms including hyper- and hypophagia, suggesting that somatic symptoms play an important role in the distinction between depressive subtypes. Analyses showed an association with BMI for the 2 hyperphagic classes but not for the 2 hypophagic classes. The inclusion of depression class improved the fit of regression models for depression predicting BMI. This suggests that the inclusion of depression subtype in analyses may clarify the association between weight and depression. Dissertation