Atypical depressive syndromes in varying definitions

Angst, Jules; Gamma, Alex; Benazzi, Franco; Silverstein, Brett; Ajdacic-Gross, Vladeta; Eich, Dominique; Rössler, Wulf

doi:10.1007/s00406-005-0600-z

Cited by 107 publications

(94 citation statements)

References 55 publications

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“…However, the hierarchical DSM-IV definition of atypical depression has been debated in adults and adolescents. 45,47 In addition, mood reactivity did not play an important part in distinguishing subtypes in one previous LCA study. 20 …”

Section: Subtypes and Correlatesmentioning

confidence: 76%

Structure of major depressive disorder in adolescents and adults in the US general population

Lamers

Burstein

et al. 2012

Br J Psychiatry

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BackgroundAlthough techniques such as latent class analysis have been used to derive empirically based subtypes of depression in adult samples, there is limited information on subtypes of depression in youth.AimsTo identify empirically based subtypes of depression in a nationally representative sample of US adolescents, and to test the comparability of subtypes of depression in adolescents with those derived from a nationally representative sample of adults.MethodRespondents included 912 adolescents and 805 adults with a 12-month major depressive disorder, selected from the National Comorbidity Survey Adolescent Supplement and the National Comorbidity Survey Replication samples respectively. Latent class analysis was used to identify subtypes of depression across samples. Sociodemographic and clinical correlates of derived subtypes were also examined to establish their validity.ResultsThree subtypes of depression were identified among adolescents, whereas four subtypes were identified among adults. Two of these subtypes displayed similar diagnostic profiles across adolescent and adult samples (P=0.43); these subtypes were labelled ‘severe typical’ (adults 45%, adolescents 35%) and ‘atypical’ (adults 16%, adolescents 26%). The latter subtype was characterised by increased appetite and weight gain.ConclusionsThe structure of depression observed in adolescents is highly similar to the structure observed in adults. Longitudinal research is necessary to evaluate the stability of these subtypes of depression across development.

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Section: Subtypes and Correlatesmentioning

confidence: 76%

Structure of major depressive disorder in adolescents and adults in the US general population

Lamers

Burstein

et al. 2012

Br J Psychiatry

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“…The cross-sectional symptoms to study should be the symptoms showing the highest prevalence difference between BP-II and MDD depression. Atypical depression symptoms and the hypomanic symptoms of mixed depression were more common in BP-II depression than in MDD depression [21, 37, 48,88,89,90,91]. Finding a bimodal distribution of these symptoms would support a categorical distinction between BP-II and MDD.…”

Section: Resultsmentioning

confidence: 99%

“…First-degree relatives of BP probands had more BP [11], age at onset was lower in BP [57, 105, 106], females were as common as males in BP-I and more common than males in MDD [21, 57, 105, 106], BP-I depression was more atypical and retarded, MDD depression was more sleepless and agitated [19, 21, 57], BP had more recurrences [17, 21, 23], and a strong diagnostic stability [12, 13] not shown by MDD [99, 100]. Regarding BP-II depression, it was more atypical, mixed, and agitated than MDD [54, 88, 90, 91,105,106,107], but not always [108, 109]. …”

Section: Resultsmentioning

confidence: 99%

Is There a Continuity between Bipolar and Depressive Disorders?

Benazzi¹

2007

Psychother Psychosom

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Background: Recent studies questioned the current categorical split of mood disorders into bipolar disorders (BP) and depressive disorders (MDD). Methods: Medline database search of papers from the last 10 years on the categorical-dimensional classification of mood disorders. Various combinations of the following key words were used: mood disorders, bipolar, unipolar, major depressive disorder, spectrum, category/categorical, classification, continuity. Only English language clinical papers were included, review papers were excluded, similar papers selected by quality. The number of papers found was 1,141. The number of papers selected was 109. Results: The continuity/spectrum between BP (mainly BP-II) and MDD was supported by the following findings:(1) high frequency of mixed states (mixed mania, mixed hypomania, mixed depression, i.e. co-occurring depression and noneuphoric manic/hypomanic symptoms) because opposite polarity symptoms in the same episode do not support a hypomania/mania-depression splitting; (2) MDD was the most common mood disorder in BP probands’ relatives; (3) no bimodal distribution of distinguishing symptoms between BP and MDD; (4) bipolar signs not uncommon in MDD; (5) many MDD shifting to BP; (6) many lifetime manic/hypomanic symptoms in MDD; (7) correlation between lifetime manic/hypomanic symptoms and MDD symptoms; (8) hypomania factors in MDD; (9) MDD often recurrent; (10) similar cognitive style.The categorical distinction between BP (mainly BP-I) and MDD was supported by the following findings: (1) BP more common in BP probands’ relatives; (2) lower age at BP onset; (3) females as common as males in BP-I, more common than males in MDD; (4) BP-I depression more atypical and retarded, MDD depression more sleepless and agitated; (5) BP more recurrent. Conclusions: Focusing on mood spectrum’s extremes (BP-I vs. MDD), a categorical distinction seems supported. Focusing on midway disorders (BP-II and MDD plus bipolar signs), a continuity/spectrum seems supported. Results seem to support both a categorical and a dimensional view of mood disorders.

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“…They concluded that their findings did not support the use of a hierarchical ranking of mood reactivity to diagnose atypical depression. They expanded upon this impression in a more recent analysis (Angst et al, 2006) and concluded that the diagnosis of atypical depression could be made with equal utility if either three of five criteria (including mood reactivity) or two of four criteria (excluding mood reactivity) were used.…”

Section: Validity Of Dsm-iv Atypical Depressionmentioning

confidence: 99%

Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria

Thase

2009

Neuropsychopharmacol

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Stewart et al (2009) have outlined the evidence in support of the validity of the DSM-IV definition of the 'With Atypical Features' episode specifier. Although recognizing the historical significance and clinical utility of the concept of atypical depression, this article takes issue with the DSM-IV criteria. It is concluded that mood reactivity, the A or obligative criterion, is neither significantly associated with the other symptomatic criteria nor useful to diagnose atypical depression, and thus should be eliminated. Problems with operationalization, specification, and reliability of ratings of the diagnostic criteria further limit validity. Despite these limitations in classification, many of the features associated with atypical depression are linked to an early onset of affective illness, including trait-like interpersonal sensitivity, comorbid social anxiety and agoraphobia, a history of childhood physical or sexual trauma, and indicators of the 'soft' side of the bipolar spectrum. Neurophysiologic studies also suggest that chronic, early-onset atypical depressions differ from both melancholia and normality. Re-analyses of the Columbia group's seminal studies suggest that preferential response to phenelzine vs imipramineFarguably the strongest validator of atypical depressionFsimilarly appears to be limited to patients with chronic, early-onset syndromes. The criteria for atypical depression need to be revised in DSM-V, including sharpening the operational definitions for the specific symptoms. The importance of age of onset and comorbid anxiety warrant further study. Research examining the validity of a subform of atypical depression characterized by trait-like interpersonal sensitivity and a chronic, early-onset course may further enhance the clinical utility of the DSM-V classification.

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Atypical depressive syndromes in varying definitions

Cited by 107 publications

References 55 publications

Structure of major depressive disorder in adolescents and adults in the US general population

Structure of major depressive disorder in adolescents and adults in the US general population

Is There a Continuity between Bipolar and Depressive Disorders?

Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria

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