Atypical Depression
© John McManamy
Don't be fooled. "Atypical" depression is actually the most common subtype of depression in outpatients, according to Andrew Nierenberg MD, Associate Director of the Depression and Clinical Research Program at Massachusetts General Hospital, affecting anywhere from 25 to 42 percent of the depressed population.
According to the DSM-IV, as opposed to major depression, the patient with atypical features experiences mood reactivity, with improved mood when something good happens. In addition, the DSM-IV mandates at least two of the following: increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression); excessive sleeping (as opposed to insomnia); leaden paralysis; and sensitivity to rejection.
A study by Agosti and Stewart published in the Journal of Affective Disorders in 2001 found that patients with atypical depression experienced greater functional impairment than their non-atypical counterparts, as well as exhibiting more interpersonal sensitivity, more chronic dysphoria, and more bipolar II disorder. Women comprised 70 percent of the study population of those with atypical depression.
A study by Posternak and Zimmerman published in Psychiatry Research in 2001 cast doubt on the only feature of atypical depression that is mandatory under the DSM - that of mood reactivity. In their study, the authors evaluated the five symptoms of atypical depression across five different groups of patients (including women, different age groups, and according to severity and length of time of symptoms), and discovered mood reactivity only featured among the women patients, suggesting this particular criteria should be dropped.
The same study also found at best a limited association between the five atypical features among the five clinical profiles. Women, for instance, consistently displayed four of the five symptoms for atypical depression while patients under age 30 exhibited only one. Two patients, then, may have two different sets of symptoms, which suggests there is nothing typical about atypical depression.
TREATMENT
A study by McGrath et al published in the American Journal of Psychiatry in 2000 found that Prozac was no better than the tricyclic antidepressant imipramine for the treatment of atypical depression, though the side effects were less. A study by Quitkin et al published in 1993 in the British Journal of Psychiatry found a response rate of 72 percent for patients with atypical depression on the MAOI Nardil compared to 44 percent on imipramine. The American Psychiatric Association's 2000 Practice Guidelines for the Treatment of Patients with Major Depression states: "MAOIs may be particularly effective in treating subgroups of patients ... with atypical features."
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