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).
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.
Available from: J-P Jean-Philippe Lang
- "'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)  . Liebowitz et al.  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: 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.
Available from: Donald F Klein
- "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.
Available from: Ulrich Hegerl
- "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.
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