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.
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.
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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ABSTRACT: Le concept de dépression atypique est actuellement remis en question par l’avancée des connaissances neurobiologiques et par l’arrivée de nouveaux traitements agissant sur les troubles de l’humeur. Au travers d’une revue de la littérature, nous nous proposons de revenir sur les origines et les différentes définitions de cette spécification diagnostique. Nous étudierons les implications de ce concept sur le plan thérapeutique, en termes de traitements médicamenteux et de prise en charge psychothérapique. Le lien particulier entre dépression atypique et bipolarité sera discuté, ouvrant ainsi de nouvelles perspectives concernant le dépistage du risque suicidaire et des consommations de substances psychoactives. Par conséquent, nous considérons que le maintien de cette spécification diagnostique dans le futur DSM-V présente un fort intérêt clinique.
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