Antidepressant Specificity in Atypical Depression

Department of Psychiatry, College of Physicians & Surgeons, Columbia University, New York, NY.
Archives of General Psychiatry (Impact Factor: 14.48). 03/1988; 45(2):129-37.
Source: PubMed


One hundred nineteen patients who met specific criteria for atypical depression completed six weeks of double-blind, randomly assigned treatment with phenelzine sulfate, imipramine hydrochloride, or placebo. The overall response rates were 71% with phenelzine, 50% with imipramine, and 28% with placebo. Phenelzine was widely superior to placebo and also showed superiority to imipramine. Phenelzine superiority appeared even greater after an additional six-week continuation phase. Imipramine was only moderately effective in this atypical depressive sample. Unexpectedly, the superiority of either phenelzine or imipramine to placebo was largely confined to patients in subsets of the study sample who were prospectively judged to also have a history of spontaneous panic attacks and/or show hysteroid dysphoric features. This is consonant with some but not other recent findings and requires replication. Overall, the concept of atypical depression as a subtype that is preferentially responsive to monoamine oxidase inhibitors is supported.

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    • "'origine des critères actuels du DSM-IV, nous citerons principalement les travaux de l'équipe de l'université de Columbia à New York (États-Unis) [4] [5]. Liebowitz et al. [5] proposent leur propre description de la dépression atypique avec la nécessité de retrouver deux symptômes en plus de la réactivité de l'humeur, influençant fortement les futures définitions proposées par le DSM-IV. Lors de ces études de validation, les auteurs comparent généralement la réponse des patients déprimés à l'imipramine (tricyclique) et au sulfate de phénelzine (IMAO), ainsi qu'à un placebo. "
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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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    • "However, the superiority of fluoxetine over tricyclic for atypical depression was not corroborated in a larger study (McGrath et al, 2000). Collectively, these studies corroborate earlier studies suggesting relatively poor tricyclic response in depression with atypical features (Liebowitz et al, 1988; Quitkin et al, 1988; Quitkin et al, 1990). "
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    ABSTRACT: Atypical features were incorporated into the American Psychiatric Association's Diagnostic and Statistical Manual, Fourth Edition (DSM-IV, 1994) as an illness specifier for major depression and dysthymia. The validity of depression with atypical features was supported by differences relative to depression with melancholic features in syndromal symptoms, course of illness, biology, family history, and treatment response. This paper reviews post-DSM-IV literature relevant to the validity of depression with atypical features. Most studies support the pre-DSM-IV findings. Again, course of illness, biological, family, and treatment differences are shown between melancholia and depression with atypical features. Several biologic studies report nondepressed controls have mean values between depressed subjects having atypical features and other depressed patients. This suggests atypical depression is a distinct depressive group rather than a milder form of melancholia. In addition, some studies show distinctions between depressed subjects with atypical features and those having neither atypical nor melancholic features. As depression with atypical features separates not only from melancholia but also from other depressed groups and controls over a range of meaningful distinctions, we conclude it is a valid clinical syndrome, useful both heuristically and in driving treatment decisions.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 10/2009; 34(13):2625-32. DOI:10.1038/npp.2009.99 · 7.05 Impact Factor
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    • "Data from three RCTs in patients with atypical depressive disorder (Liebowitz et al., 1988; Quitkin et al., 1990, 1991) all indicated phenelzine to be superior to the TCA imipramine in terms of the response rates and effect sizes, which were in the medium range (summarized in Table 3b). However, the 95% confidence interval (CI) computed for the medium effect size (0.24) in one RCT published by Quitkin et al. (1988) suggests that phenelzine is not statistically superior to imipramine. "
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    ABSTRACT: The present meta-analysis addressed the empirical evidence regarding the treatment of major depression with atypical features. The superiority of monoamine oxidase inhibitors (MAOIs) compared with other antidepressants in the treatment of major depression with atypical features has been frequently reported. According to the CONSORT Statement, studies included in our meta-analysis had to meet several criteria, especially a double-blind, controlled condition and an operational diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-III or DSM-IV criteria, respectively. Four databases for research-based evidence were used in a systematic review: Medline, Embase, Psyndex and PsycInfo. Only eight publications met inclusion/exclusion criteria, resulting in 11 comparisons. Our results contrast an effect size of 0.45 (95% confidence interval) for a comparison of MAOIs vs. placebo with an effect size of 0.02 (95% confidence interval: - 0.10-0.14) for a comparison of MAOIs vs. selective serotonin reuptake inhibitors. The effect size for MAOIs vs. tricyclic antidepressants was 0.27 (95% confidence interval: 0.16-0.42). MAOIs may be more effective for atypical major depressive disorder than tricyclic antidepressants. Most clinical research has been conducted on irreversible MAOIs. Additional studies testing more recently developed antidepressants (including reversible MAOIs) with an improved safety profile would be warranted. The available data are insufficient for a direct comparison between MAOIs and selective serotonin reuptake inhibitors.
    Psychiatry Research 02/2006; 141(1):89-101. DOI:10.1016/j.psychres.2005.07.012 · 2.47 Impact Factor
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