Atypical depression. A valid clinical entity?

New York State Psychiatric Institute, New York.
Psychiatric Clinics of North America (Impact Factor: 2.13). 10/1993; 16(3):479-95.
Source: PubMed


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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    • "High interrater reliability has been shown for both interviews [42] [43]. Additionally the Atypical Depression Diagnostic Scale (ADDS) [44] [45] 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
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    • "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 » [6]. 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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    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 · 0.70 Impact Factor
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    • "Second, consistent with several prior multivariate analyses of MD criteria (Kendler et al. 1996; Sullivan et al. 1998; Matza et al. 2003) and depressive symptom scales (Bech et al. 2011), when atypical vegetative symptoms are well represented among the items, they form a distinct dimension of depressive symptomatology (Stewart et al. 1993). However, contrary to most prior studies of clinical criteria, perhaps because of our statistical power, we found that items reflecting sleep difficulty were moderately independent from the other vegetative symptoms reflecting changes in weight/appetite and formed their own factor. "
    Y Li · S Aggen · S Shi · J Gao · M Tao · K Zhang · X Wang · C Gao · L Yang · Y Liu · [...] · J Dong · R Pan · W Zhang · Z Shen · Z Liu · D Gu · X Liu · Q Zhang · J Flint · K S Kendler
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    ABSTRACT: The symptoms of major depression (MD) are clinically diverse. Do they form coherent factors that might clarify the underlying nature of this important psychiatric syndrome? Method Symptoms at lifetime worst depressive episode were assessed at structured psychiatric interview in 6008 women of Han Chinese descent, age ⩾30 years with recurrent DSM-IV MD. Exploratory factor analysis (EFA) and confirmatoryfactor analysis (CFA) were performed in Mplus in random split-half samples. The preliminary EFA results were consistently supported by the findings from CFA. Analyses of the nine DSM-IV MD symptomatic A criteria revealed two factors loading on: (i) general depressive symptoms; and (ii) guilt/suicidal ideation. Examining 14 disaggregated DSM-IV criteria revealed three factors reflecting: (i) weight/appetite disturbance; (ii) general depressive symptoms; and (iii) sleep disturbance. Using all symptoms (n = 27), we identified five factors that reflected: (i) weight/appetite symptoms; (ii) general retarded depressive symptoms; (iii) atypical vegetative symptoms; (iv) suicidality/hopelessness; and (v) symptoms of agitation and anxiety. MD is a clinically complex syndrome with several underlying correlated symptom dimensions. In addition to a general depressive symptom factor, a complete picture must include factors reflecting typical/atypical vegetative symptoms, cognitive symptoms (hopelessness/suicidal ideation), and an agitated symptom factor characterized by anxiety, guilt, helplessness and irritability. Prior cross-cultural studies, factor analyses of MD in Western populations and empirical findings in this sample showing risk factor profiles similar to those seen in Western populations suggest that our results are likely to be broadly representative of the human depressive syndrome.
    Psychological Medicine 08/2013; 44(7):1-11. DOI:10.1017/S003329171300192X · 5.94 Impact Factor
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