Objectives The melancholic and atypical specifiers for a major depressive episode (MDE) are supposed to reduce heterogeneity in symptom presentation by requiring additional, specific features. Fried et al. (2020) recently showed that the melancholic specifier may increase the potential heterogeneity in presenting symptoms. In a large sample of outpatients with depression, our objective was to explore whether the melancholic and atypical specifiers reduced observed heterogeneity in symptoms. Methods We used baseline data from the Inventory of Depression Symptoms (IDS), which was available for 3,717 patients, from the Sequenced Alternatives to Relieve Depression (STAR*D) trial. A subsample met criteria for MDE on the IDS (“IDS-MDE”; N =2,496). For patients with IDS-MDE, we differentiated between those with melancholic, non-melancholic, non-melancholic, atypical, and non-atypical depression. We quantified the observed heterogeneity between groups by counting the number of unique symptom combinations pertaining to their given diagnostic group (e.g., counting the melancholic symptoms for melancholic and non-melancholic groups), as well as the profiles of DSM-MDE symptoms (i.e., ignoring the specifier symptoms). Results When considering the specifier and depressive symptoms, there was more observed heterogeneity within the melancholic and atypical subgroups than in the IDS-MDE sample (i.e., ignoring the specifier subgroups). The differences in number of profiles between the melancholic and non-melancholic groups were not statistically significant, irrespective of whether focusing on the specifier symptoms or only the DSM-MDE symptoms. The differences between the atypical and non-atypical subgroups were smaller than what would be expected by chance. We found no evidence that the specifier groups reduce heterogeneity, as can be quantified by unique symptom profiles. Most symptom profiles, even in the specifier subgroups, had five or fewer individuals. Conclusion We found no evidence that the atypical and melancholic specifiers create more symptomatically homogeneous groups. Indeed, the melancholic and atypical specifiers introduce heterogeneity by adding symptoms to the DSM diagnosis of MDE.

We examined the availability and components of internet-based cognitive-behavioral therapies (iCBTs) for depression tested in randomized-controlled trials (RCTs). Our search yielded 59 studies that used 30 unique iCBTs. Of these, only seven (23%) were completely available to the public, more than half were not publicly available (57%), and the remaining 20% were available but had some restriction (e.g., geographical). When comparing iCBTs to commercially available smartphone apps, we found that iCBTs were more likely to contain psychoeducation, cognitive restructuring, behavioral activation, problem-solving, interpersonal communication, and anxiety content, and less likely to contain mindfulness. iCBTs contain evidence-based content but few are available to the public. Extending beyond efficacy, attention should be paid to the dissemination of iCBTs.

Introduction Doing What Matters in Times of Stress (DWM) is a five-module transdiagnostic guided self-help (GSH) intervention developed by the World Health Organization, originally in a group-based format. In a sample of individuals recruited from across the United States, we conducted an open trial to study the feasibility and acceptability of an adaptation of DWM in which guidance was provided individually and remotely via phone and videoconferencing. Methods We assessed internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation over the course of 6 weeks. Results A total of 263 individuals completed our screening. Of those, 75.29% ( n = 198) qualified for the intervention. We reached most participants who qualified (71.21%, n = 141) via phone to schedule a GSH session. Most of those scheduled attended a study session (84.4%, n = 119), and most of those who attended a session completed more than half the treatment (84.03%, n = 100). Retention rates were comparable to meta-analytic estimates of dropout rates in GSH. Participants showed improvement on internalizing symptoms, psychological well-being, work and social functioning, usability of the intervention, and emotion regulation. Conclusion DWM is a freely available, seemingly efficacious transdiagnostic intervention for internalizing disorder symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s10608-022-10338-5.

Objectives: Although specifiers for a major depressive disorder (MDE) are supposed to reduce diagnostic heterogeneity, recent literature challenges the idea that the atypical and melancholic features identify more homogenous or coherent subgroups. We attempt to replicate these findings and explore whether symptom heterogeneity is reduced in depression subgroups using novel data-analytic techniques. Methods: Using data derived from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC Wave I; N = 5,749) and Sequenced Treatment Alternatives to Relieve Depression (STAR*D; N = 2,498) we computed the Hamming and Manhattan distance ratios comparing within and between individuals for the melancholic and atypical specifier subgroups. Results: In neither of the datasets was the heterogeneity between subgroups higher than the heterogeneity within subgroups, suggesting that the melancholic and atypical specifiers do not create more coherent (i.e., more homogeneous) subgroups. Conclusion: Replicating prior work, melancholic and atypical depression subtypes appear to have limited utility in reducing heterogeneity. The current study does not support the claim that symptom and course specifiers create more coherent subgroups as operationalized by similarity in symptoms and their severity.

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