ATYPICAL DEPRESSION - CLINICAL ASPECTS AND NORADRENERGIC FUNCTION

Objective: The authors assessed the frequency of atypical depression i n depressed outpatients and compared clinical and biological features of patients with atypical and nonatypical depression. Method: Depresse d outpatients (N=114) were diagnosed with the Schedule for Affective D isorders and Schizophrenia (SADS) according to Research Diagnostic Cri teria. Patients were assessed for presence or absence of atypical depr ession with the Atypical Depressive Disorder Scale. Atypical depressio n was defined as the presence of mood reactivity during the depressive episode, along with at least one of four associated features: hyperso mnia, hyperphagia, leaden paralysis, and rejection sensitivity. All pa tients completed the SCL-90 and were rated with the Hamilton Depressio n Rating Scale, extracted from the SADS. To assess biological function ing, the authors examined cortisol response to 75 mg of desipramine, a relatively selective norepinephrine reuptake inhibitor. Results: Twen ty-nine percent of patients met criteria for atypical depression. Pati ents with atypical depression were significantly more likely to be fem ale. Patients with atypical and nonatypical depression did not differ on SCL-90 subscale scores. Although extracted Hamilton depression scal e scores were significantly higher for patients with nonatypical depre ssion, the difference was not clinically significant. Patients with at ypical depression exhibited a significantly different cortisol respons e to desipramine injection than patients with nonatypical depression, which suggested that nonatypical depression may be associated with a m ore impaired norepinephrine system. Conclusions: In view of data in th is study, as well as earlier studies, atypical depression has a unique symptom profile, may be widely prevalent, has a distinct treatment re sponse, and may indicate a less impaired biological system than nonaty pical depression. Since this is the first report to evaluate the frequ ency of atypical depression as well as the norepinephrine system in at ypical depression, this study needs to be replicated Nonetheless, the data support the inclusion of atypical depression as a subtype of the depressive disorders an DSM-IV.