New Directions in the Treatment of Atypical Depression

Atypical depression, oneof the 4 historically important ways of subdividing depression, was first usedby West and Dally to describe a patient subgroup that was nonresponsive toimipramine but responsive to iproniazid. The definition was later refined toinclude reverse vegetative and hysteroid dysphoria symptoms, presaging adoptionof the current DSM definition in 1984. However, focusing on hysteroid dysphoriasymptoms drew attention away from anxiety symptoms, some of which are morestrongly linked to atypical depression. Studies that have attempted to validateatypical depression have reinforced reverse vegetative symptoms criteria andhave shown that atypical depression is probably more common than melancholia.Studies suggest that atypical depression is not preferentially responsive tomonoamine oxidase inhibitors, but rather less responsive to tricyclicantidepressants.

Atypical depression, oneof the 4 historically important ways of subdividing depression, was first usedby West and Dally to describe a patient subgroup that was nonresponsive toimipramine but responsive to iproniazid. The definition was later refined toinclude reverse vegetative and hysteroid dysphoria symptoms, presaging adoptionof the current DSM definition in 1984. However, focusing on hysteroid dysphoriasymptoms drew attention away from anxiety symptoms, some of which are morestrongly linked to atypical depression. Studies that have attempted to validateatypical depression have reinforced reverse vegetative symptoms criteria andhave shown that atypical depression is probably more common than melancholia.Studies suggest that atypical depression is not preferentially responsive tomonoamine oxidase inhibitors, but rather less responsive to tricyclicantidepressants

Fromthe Department of Psychiatry, University of Pittsburgh School of Medicine,Western Psychiatric Institute and Clinic, Pittsburgh, Penn.

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