Fm. Quitkin et al., COLUMBIA ATYPICAL DEPRESSION - A SUBGROUP OF DEPRESSIVES WITH BETTER RESPONSE TO MAOI THAN TO TRICYCLIC ANTIDEPRESSANTS OR PLACEBO, British Journal of Psychiatry, 163, 1993, pp. 30-34
We summarise a series of studies using a MAOI to help establish the va
lidity of a subgroup of depressives referred to as atypical depressive
s. Patients with reactive mood meeting DSM-III criteria for depressive
illness who had associated atypical features (which include hyperphag
ia, hypersomnolence, leaden paralysis, and rejection sensitivity) were
randomised to imipramine, phenelzine and placebo. Non-responders were
crossed over, and in all there were over 400 patient trials. Phenelzi
ne consistently was found to be superior to imipramine. Only in trials
which included patients lacking atypical, vegetative symptoms was imi
pramine found to equal phenelzine. We conclude that the researcher and
the clinician should consider the relevance of the atypical depressiv
e syndrome.