THE VALIDITY OF ATYPICAL DEPRESSION IN DSM-IV

Atypical depression has been included in the DSM-IV as an episode spec ifier of major depressive episodes end dysthymia. This report will rev iew evidence for the clinical validity of atypical depression using op erational criteria for the validation of clinical syndromes. English l anguage articles between 1969 and March 1996 were found using a comput erized and manual reference search and were selected according to the following criteria: (1) primary research, (2) definition of atypical d epression, which includes depression and not anxiety alone, and (3) re levance of data for validation of atypical depression. Studies were ev aluated on Kendall's six criteria for establishing clinical validity. There are supporting data for diagnostic validity of atypical depressi on in the criteria of clinical description and differential treatment response, with atypical depression having a superior response to monoa mine oxidase (MAO) inhibitors compared to tricyclic antidepressants. T here is still only limited support for the validity of atypical depres sion in the criteria of pathophysiology, points of rarity with other s imilar diagnoses, distinctive course and outcome, and genetics. Based an the current evidence, atypical depression is a useful diagnostic co ncept, particularly for predicting differential drug response, but fur ther research is required to conclusively demonstrate its validity as a clinical syndrome. Copyright (C) 1996 by W.B. Saunders Company