Are in-patient depressives more often of the melancholic subtype?

In contrast to out-patients, hospitalized depressed patients have been repo rted to respond better to tricyclic antidepressants (TCAs) than to selectiv e serotonin reuptake inhibitors (SSRls) and moclobemide. This may be due to differences in the type of patients included in the trials. The hypothesis that hospitalized depressed patients have a different symptom profile to o ut-patients was tested by comparing 352 patients from three in-patient stud ies with 581 patients from three out-patient studies conducted in Denmark d uring the period 1980-1992. All patients had major depression and were eval uated using the Hamilton Depression Scale. The full version of the Newcastl e Diagnostic Rating Scale (1965) was applied to 443 of the patients. m-pati ents were characterized by higher scores on the items 'depressed mood','sui cidal impulses','work and interest (reduced): 'retardation', 'distinct qual ity of depression','weight loss',feeling of guilt' and 'nihilistic delusion s', and by lower scores on the items 'somatic complaints', 'hypochondriasis ', 'psychological stressors' and 'anxiety'. In total, 76% of the in-patient s and 40% of the out-patients had melancholic/endogenous depression. These findings may explain why TCAs are superior to SSRIs and moclobemide in hosp italized patients, since other data indicate that TCAs seem to be the most effective treatment for the melancholic/endogenous subtype.