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Patrick J Mcgrath - One of the best experts on this subject based on the ideXlab platform.
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Atypical Depression current status and relevance to melancholia
Acta Psychiatrica Scandinavica, 2007Co-Authors: J W Stewart, Patrick J Mcgrath, Frederic M Quitkin, D F KleinAbstract:Objective: The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV, 1994) included Atypical features as an illness specifier for major Depression and dysthymia. We asked whether subsequent literature supported its validity and addressed the relationship between Depression with Atypical features and melancholia. Method: Literature review focusing on studies addressing the validity of Atypical Depression, supplemented by the authors' previously unpublished data. Results: Most studies support the discriminant validity of Depression with Atypical features relative to melancholia and Depression having neither melancholic nor Atypical features. However, studies addressing illness course suggest that criteria for Depression with Atypical features define a heterogeneous patient population. Conclusion: DSM-IV criteria for Depression with Atypical features define a valid, but heterogeneous disorder. Criteria including age of onset and chronicity may define a more homogeneous group that is distinct from both melancholia and other depressed patients.
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Do age of onset and course of illness define biologically distinct groups within Atypical Depression?
Journal of Abnormal Psychology, 2003Co-Authors: Jonathan W. Stewart, Patrick J Mcgrath, Gerard E Bruder, Frederic M QuitkinAbstract:Illness course separates patients with Atypical Depression into tricyclic responders and nonresponders as does perceptual asymmetry. The authors therefore investigated whether the course-of-illness parameters would define groups within Atypical Depression differing in brain laterality. Patients with Atypical Depression were assessed for illness course and brain laterality. Two patient groups were defined, 1 with onset prior to age 20 plus a very chronic course, and a 2nd group having later onset or less chronic illness. Patients reporting early onset of very chronic dysphoria showed significantly less right-ear (left-hemisphere) accuracy and also differed in characteristic perceptual asymmetry when compared to patients with later onset or less chronicity. Course of illness may usefully define more homogeneous depressive subgroups within Atypical Depression.
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Comparison of the effects of fluoxetine, imipramine and placebo on personality in Atypical Depression.
Journal of Affective Disorders, 2002Co-Authors: Vito Agosti, Patrick J McgrathAbstract:Background: Atypical Depression is associated with elevated rates of personality disorders. Studies have confirmed the efficacy of a several antidepressants in the treatment of Atypical Depression. Whether their pathological dimensions of personality diminish after benefitting from effective medication treatment is unclear. Aims: To determine the extent that pathological dimensions of character improved among patients who benefitted from treatment. Method: One-hundred and fifty-four outpatients with DSM-IV Major Depression who met Columbia criteria for Atypical Depression were randomized to receive fluoxetine, imipramine or placebo for a 10-week double-blind clinical trial. The Temperament and Character Inventory (TCI) was administered at the initiation of treatment and 8 weeks later. Low scores on either of two Character dimensions (Self-Directiveness or Cooperativeness) indicate psychopathology. Results: Responders had a substantial reduction in Harm Avoidance, but post-treatment scores remained significantly higher than the normal control group (NCG). Fluoxetine and Imipramine did not produce different changes on personality, except for Self-Transcendence. Limitations: High proportion of missing data, inadequate sample size, post-hoc analysis. Conclusions: Among responders, Self-Directiveness improved and normalized; Harm Avoidance also improved but did not normalize. These data suggests that effective treatments reduce some pathological personality traits as well as improving mood.
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Atypical Depression: enhanced right hemispheric dominance for perceiving emotional chimeric faces.
Journal of abnormal psychology, 2002Co-Authors: Gerard E Bruder, Patrick J Mcgrath, Jonathan W. Stewart, Guoguang Julie, Bruce E. Wexler, Frederic M QuitkinAbstract:Two studies compared hemispatial bias for perceiving chimeric faces in patients having either Atypical or typical Depression and healthy controls. A total of 245 patients having major depressive disorder (MDD) or dysthymia (164 with Atypical features) and 115 controls were tested on the Chimeric Faces Test. Atypical Depression differed from typical Depression and controls in showing abnormally large right hemisphere bias. This was present in patients having either MDD or dysthymia and was not related to anxiety, physical anhedonia, or vegetative symptoms. In contrast, patients having MDD with melancholia showed essentially no right hemisphere bias. This is further evidence that Atypical Depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.
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Comparison of the effects of fluoxetine, imipramine and placebo on personality in Atypical Depression.
Journal of affective disorders, 2002Co-Authors: Vito Agosti, Patrick J McgrathAbstract:Atypical Depression is associated with elevated rates of personality disorders. Studies have confirmed the efficacy of a several antidepressants in the treatment of Atypical Depression. Whether their pathological dimensions of personality diminish after benefitting from effective medication treatment is unclear. To determine the extent that pathological dimensions of character improved among patients who benefitted from treatment. One-hundred and fifty-four outpatients with DSM-IV Major Depression who met Columbia criteria for Atypical Depression were randomized to receive fluoxetine, imipramine or placebo for a 10-week double-blind clinical trial. The Temperament and Character Inventory (TCI) was administered at the initiation of treatment and 8 weeks later. Low scores on either of two Character dimensions (Self-Directiveness or Cooperativeness) indicate psychopathology. Responders had a substantial reduction in Harm Avoidance, but post-treatment scores remained significantly higher than the normal control group (NCG). Fluoxetine and Imipramine did not produce different changes on personality, except for Self-Transcendence. High proportion of missing data, inadequate sample size, post-hoc analysis. Among responders, Self-Directiveness improved and normalized; Harm Avoidance also improved but did not normalize. These data suggests that effective treatments reduce some pathological personality traits as well as improving mood.
Frederic M Quitkin - One of the best experts on this subject based on the ideXlab platform.
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Atypical Depression current status and relevance to melancholia
Acta Psychiatrica Scandinavica, 2007Co-Authors: J W Stewart, Patrick J Mcgrath, Frederic M Quitkin, D F KleinAbstract:Objective: The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV, 1994) included Atypical features as an illness specifier for major Depression and dysthymia. We asked whether subsequent literature supported its validity and addressed the relationship between Depression with Atypical features and melancholia. Method: Literature review focusing on studies addressing the validity of Atypical Depression, supplemented by the authors' previously unpublished data. Results: Most studies support the discriminant validity of Depression with Atypical features relative to melancholia and Depression having neither melancholic nor Atypical features. However, studies addressing illness course suggest that criteria for Depression with Atypical features define a heterogeneous patient population. Conclusion: DSM-IV criteria for Depression with Atypical features define a valid, but heterogeneous disorder. Criteria including age of onset and chronicity may define a more homogeneous group that is distinct from both melancholia and other depressed patients.
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Do age of onset and course of illness define biologically distinct groups within Atypical Depression?
Journal of Abnormal Psychology, 2003Co-Authors: Jonathan W. Stewart, Patrick J Mcgrath, Gerard E Bruder, Frederic M QuitkinAbstract:Illness course separates patients with Atypical Depression into tricyclic responders and nonresponders as does perceptual asymmetry. The authors therefore investigated whether the course-of-illness parameters would define groups within Atypical Depression differing in brain laterality. Patients with Atypical Depression were assessed for illness course and brain laterality. Two patient groups were defined, 1 with onset prior to age 20 plus a very chronic course, and a 2nd group having later onset or less chronic illness. Patients reporting early onset of very chronic dysphoria showed significantly less right-ear (left-hemisphere) accuracy and also differed in characteristic perceptual asymmetry when compared to patients with later onset or less chronicity. Course of illness may usefully define more homogeneous depressive subgroups within Atypical Depression.
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Atypical Depression: enhanced right hemispheric dominance for perceiving emotional chimeric faces.
Journal of abnormal psychology, 2002Co-Authors: Gerard E Bruder, Patrick J Mcgrath, Jonathan W. Stewart, Guoguang Julie, Bruce E. Wexler, Frederic M QuitkinAbstract:Two studies compared hemispatial bias for perceiving chimeric faces in patients having either Atypical or typical Depression and healthy controls. A total of 245 patients having major depressive disorder (MDD) or dysthymia (164 with Atypical features) and 115 controls were tested on the Chimeric Faces Test. Atypical Depression differed from typical Depression and controls in showing abnormally large right hemisphere bias. This was present in patients having either MDD or dysthymia and was not related to anxiety, physical anhedonia, or vegetative symptoms. In contrast, patients having MDD with melancholia showed essentially no right hemisphere bias. This is further evidence that Atypical Depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.
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A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of Atypical Depression.
The American journal of psychiatry, 2000Co-Authors: Patrick J Mcgrath, Frederic M Quitkin, Jonathan W. Stewart, Malvin N. Janal, Eva Petkova, D F KleinAbstract:OBJECTIVE: The Atypical subtype of Depression appears to be both well validated and common. Although monoamine oxidase inhibitors are effective in treating Atypical Depression, their side effects and prescription-associated dietary restrictions reduce their suitability as a first-line treatment. The objective of this study was to estimate the efficacy of the selective serotonin reuptake inhibitor (SSRI) fluoxetine in the treatment of major Depression with Atypical features. METHOD: One hundred fifty-four subjects with DSM-IV major Depression who met the Columbia criteria for Atypical Depression were randomly assigned to receive fluoxetine, imipramine, or placebo for a 10-week clinical trial. Imipramine was included because its known efficacy for treatment of Atypical Depression helped to calibrate the appropriateness of the study group. RESULTS: In both intention-to-treat and completer groups, the effectiveness of both fluoxetine and imipramine was significantly better than that of placebo. The two medica...
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Prophylactic efficacy of phenelzine and imipramine in chronic Atypical Depression: likelihood of recurrence on discontinuation after 6 months' remission.
The American journal of psychiatry, 1997Co-Authors: Jonathan W. Stewart, Patrick J Mcgrath, E Tricamo, Frederic M QuitkinAbstract:Objective: Demonstration of antidepressant efficacy beyond 6 months has infrequently been addressed, and no long-term efficacy data exist for patients with chronic Atypical Depression. Method: Sixty patients with Atypical Depression (according to Columbia University criteria) of at least 2 years’ duration and who had improved with imipramine or phenelzine were stabilized for 6 months and then randomly continued the same medication or placebo for 6 months. Results: Several baseline differences suggested that patients who entered the discontinuation trial on a regimen of phenelzine were more chronically depressed than the imipramine-treated patients. Survival analysis showed a marked advantage for phenelzine relative to placebo. In addition, patients switched to placebo from phenelzine experienced a recurrence of depressive symptoms significantly more often than patients switched to placebo from imipramine. Patients maintained with imipramine did not have lower relapse rates than those switched from imipramine to placebo. Recurrence rates were 23% for patients maintained on a regimen of phenelzine, 41% for those maintained on a regimen of imipramine, 47% for those switched from imipramine to placebo, and 87% for placebo-treated patients originally treated with phenelzine. Conclusions: Patients with chronic Atypical Depression are at high risk of recurrence if phenelzine is withdrawn 6 months after initial improvement. Similar findings were not demonstrated for imipramine; this replicates acute trials demonstrating imipramine’s relative ineffectiveness in patients with Atypical Depression. Differences in recurrence rates after the switch to placebo from phenelzine and imipramine could be due to the two drugs’ different mechanisms of action or to baseline differences in the two populations. (Am J Psychiatry 1997; 154:31‐36)
D F Klein - One of the best experts on this subject based on the ideXlab platform.
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Atypical Depression current status and relevance to melancholia
Acta Psychiatrica Scandinavica, 2007Co-Authors: J W Stewart, Patrick J Mcgrath, Frederic M Quitkin, D F KleinAbstract:Objective: The Diagnostic and Statistical Manual, Fourth Edition (DSM-IV, 1994) included Atypical features as an illness specifier for major Depression and dysthymia. We asked whether subsequent literature supported its validity and addressed the relationship between Depression with Atypical features and melancholia. Method: Literature review focusing on studies addressing the validity of Atypical Depression, supplemented by the authors' previously unpublished data. Results: Most studies support the discriminant validity of Depression with Atypical features relative to melancholia and Depression having neither melancholic nor Atypical features. However, studies addressing illness course suggest that criteria for Depression with Atypical features define a heterogeneous patient population. Conclusion: DSM-IV criteria for Depression with Atypical features define a valid, but heterogeneous disorder. Criteria including age of onset and chronicity may define a more homogeneous group that is distinct from both melancholia and other depressed patients.
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A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of Atypical Depression.
The American journal of psychiatry, 2000Co-Authors: Patrick J Mcgrath, Frederic M Quitkin, Jonathan W. Stewart, Malvin N. Janal, Eva Petkova, D F KleinAbstract:OBJECTIVE: The Atypical subtype of Depression appears to be both well validated and common. Although monoamine oxidase inhibitors are effective in treating Atypical Depression, their side effects and prescription-associated dietary restrictions reduce their suitability as a first-line treatment. The objective of this study was to estimate the efficacy of the selective serotonin reuptake inhibitor (SSRI) fluoxetine in the treatment of major Depression with Atypical features. METHOD: One hundred fifty-four subjects with DSM-IV major Depression who met the Columbia criteria for Atypical Depression were randomly assigned to receive fluoxetine, imipramine, or placebo for a 10-week clinical trial. Imipramine was included because its known efficacy for treatment of Atypical Depression helped to calibrate the appropriateness of the study group. RESULTS: In both intention-to-treat and completer groups, the effectiveness of both fluoxetine and imipramine was significantly better than that of placebo. The two medica...
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The treatment of Atypical Depression
European Psychiatry, 1993Co-Authors: D F KleinAbstract:SummaryAtypical Depression differs from typical (endogenomorphic) Depression not only in terms of the primary determinant, mood reactivity, but also by the presence of at least one of four Atypical symptoms, hyperphagia, hypersomnia, rejection sensitivity and leaden paralysis. In addition to the differential therapeutic response reported by various authors, these two types of Depression can be differentiated by various biological measures including the dexamethasone suppression test, tyramine excretion following loading, REM latency, etc. A series of studies comparing phenelzine with imipramine and placebo in subgroups of Atypical depressives showed better results with the tricyclic than with placebo; however phenelzine consistently gave the best results in this type of Depression. The hypothesis is advanced that the difference between typical and Atypical classes of Depression could be accounted for by the loss of the ability to experience both “anticipatory” or “consummatory” pleasure in typical Depression, but only anticipatory pleasure in Atypical Depression.
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Predictive value of symptoms of Atypical Depression for differential drug treatment outcome.
Journal of clinical psychopharmacology, 1992Co-Authors: Patrick J Mcgrath, Frederic M Quitkin, Jonathan W. Stewart, Judith G. Rabkin, W Harrison, E Tricamo, Katja Ocepek-welikson, Edward N. Nunes, Steven Wager, D F KleinAbstract:Data for 401 depressed outpatients with mood reactivity who participated in a randomized trial comparing placebo, imipramine, and phenelzine were analyzed for predictors of differential response by stepwise multiple regression techniques. Features of the Columbia criteria for Atypical Depression including oversleeping, overeating, severe anergy, and pathologic rejection sensitivity were each predictive of a poorer response to imipramine than to phenelzine only when compared to those patients with none of the features. These features were not additive in their contribution to differential outcome. Lack of endogenous features was not predictive of a differential drug treatment response. Compared with patients who have no symptoms of Atypical Depression, patients with any of the four features had an inferior imipramine response rather than a superior phenelzine response. These analyses indicate that the clear differential responsivity to medication treatment in Atypical Depression is not simply related to any one defining symptom and that further correlates of this apparent biological heterogeneity need to be explored.
Jonathan W. Stewart - One of the best experts on this subject based on the ideXlab platform.
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Do age of onset and course of illness define biologically distinct groups within Atypical Depression?
Journal of Abnormal Psychology, 2003Co-Authors: Jonathan W. Stewart, Patrick J Mcgrath, Gerard E Bruder, Frederic M QuitkinAbstract:Illness course separates patients with Atypical Depression into tricyclic responders and nonresponders as does perceptual asymmetry. The authors therefore investigated whether the course-of-illness parameters would define groups within Atypical Depression differing in brain laterality. Patients with Atypical Depression were assessed for illness course and brain laterality. Two patient groups were defined, 1 with onset prior to age 20 plus a very chronic course, and a 2nd group having later onset or less chronic illness. Patients reporting early onset of very chronic dysphoria showed significantly less right-ear (left-hemisphere) accuracy and also differed in characteristic perceptual asymmetry when compared to patients with later onset or less chronicity. Course of illness may usefully define more homogeneous depressive subgroups within Atypical Depression.
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Atypical Depression: enhanced right hemispheric dominance for perceiving emotional chimeric faces.
Journal of abnormal psychology, 2002Co-Authors: Gerard E Bruder, Patrick J Mcgrath, Jonathan W. Stewart, Guoguang Julie, Bruce E. Wexler, Frederic M QuitkinAbstract:Two studies compared hemispatial bias for perceiving chimeric faces in patients having either Atypical or typical Depression and healthy controls. A total of 245 patients having major depressive disorder (MDD) or dysthymia (164 with Atypical features) and 115 controls were tested on the Chimeric Faces Test. Atypical Depression differed from typical Depression and controls in showing abnormally large right hemisphere bias. This was present in patients having either MDD or dysthymia and was not related to anxiety, physical anhedonia, or vegetative symptoms. In contrast, patients having MDD with melancholia showed essentially no right hemisphere bias. This is further evidence that Atypical Depression is a biologically distinct subtype and underscores the importance of this diagnostic distinction for neurophysiologic studies.
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A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of Atypical Depression.
The American journal of psychiatry, 2000Co-Authors: Patrick J Mcgrath, Frederic M Quitkin, Jonathan W. Stewart, Malvin N. Janal, Eva Petkova, D F KleinAbstract:OBJECTIVE: The Atypical subtype of Depression appears to be both well validated and common. Although monoamine oxidase inhibitors are effective in treating Atypical Depression, their side effects and prescription-associated dietary restrictions reduce their suitability as a first-line treatment. The objective of this study was to estimate the efficacy of the selective serotonin reuptake inhibitor (SSRI) fluoxetine in the treatment of major Depression with Atypical features. METHOD: One hundred fifty-four subjects with DSM-IV major Depression who met the Columbia criteria for Atypical Depression were randomly assigned to receive fluoxetine, imipramine, or placebo for a 10-week clinical trial. Imipramine was included because its known efficacy for treatment of Atypical Depression helped to calibrate the appropriateness of the study group. RESULTS: In both intention-to-treat and completer groups, the effectiveness of both fluoxetine and imipramine was significantly better than that of placebo. The two medica...
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Prophylactic efficacy of phenelzine and imipramine in chronic Atypical Depression: likelihood of recurrence on discontinuation after 6 months' remission.
The American journal of psychiatry, 1997Co-Authors: Jonathan W. Stewart, Patrick J Mcgrath, E Tricamo, Frederic M QuitkinAbstract:Objective: Demonstration of antidepressant efficacy beyond 6 months has infrequently been addressed, and no long-term efficacy data exist for patients with chronic Atypical Depression. Method: Sixty patients with Atypical Depression (according to Columbia University criteria) of at least 2 years’ duration and who had improved with imipramine or phenelzine were stabilized for 6 months and then randomly continued the same medication or placebo for 6 months. Results: Several baseline differences suggested that patients who entered the discontinuation trial on a regimen of phenelzine were more chronically depressed than the imipramine-treated patients. Survival analysis showed a marked advantage for phenelzine relative to placebo. In addition, patients switched to placebo from phenelzine experienced a recurrence of depressive symptoms significantly more often than patients switched to placebo from imipramine. Patients maintained with imipramine did not have lower relapse rates than those switched from imipramine to placebo. Recurrence rates were 23% for patients maintained on a regimen of phenelzine, 41% for those maintained on a regimen of imipramine, 47% for those switched from imipramine to placebo, and 87% for placebo-treated patients originally treated with phenelzine. Conclusions: Patients with chronic Atypical Depression are at high risk of recurrence if phenelzine is withdrawn 6 months after initial improvement. Similar findings were not demonstrated for imipramine; this replicates acute trials demonstrating imipramine’s relative ineffectiveness in patients with Atypical Depression. Differences in recurrence rates after the switch to placebo from phenelzine and imipramine could be due to the two drugs’ different mechanisms of action or to baseline differences in the two populations. (Am J Psychiatry 1997; 154:31‐36)
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Gepirone treatment of Atypical Depression: preliminary evidence of serotonergic involvement.
Journal of Clinical Psychopharmacology, 1994Co-Authors: Patrick J Mcgrath, Stephen Wager, Stephen W. Jenkins, Donald G. Archibald, Joseph C. Stringfellow, Frederic M Quitkin, Jonathan W. Stewart, Donald S. RobinsonAbstract:: This is a report of a controlled trial of gepirone, a 5-hydroxytryptamine (5-HT1A) partial agonist azapirone related to buspirone, in the treatment of Atypical Depression. The azapirones are of particular interest because their highly selective actions on the serotonergic system may possibly make them useful pharmacologic probes and potentially selective therapeutic agents. Sixty outpatients meeting Columbia criteria for definite or probable Atypical Depression were enrolled in a double-blind, randomized, placebo-controlled, 8-week clinical trial at a single site. The dosage schedule was fixed flexible, with 10-mg capsules given on a thrice-daily schedule, with doses of up to 120 mg daily. The response rate at 8 weeks for the intention-to-treat sample analyzed with the last observation carried forward was 62% (18 of 29 patients) for gepirone and 20% (6 of 30 patients) for placebo (chi 2 = 9.1; df = 1; p < 0.001). Robust and consistent drug-placebo differences are seen across virtually all rating scales post-treatment. The effect of gepirone was consistent across the levels of concomitant variables, including duration of episode and presence of dysthymia or panic. Gepirone is a novel antidepressant that holds promise for the treatment of Atypical Depression and that may be of heuristic value because of its relatively specific actions on the serotonergic system.
Michael E Thase - One of the best experts on this subject based on the ideXlab platform.
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Atypical Depression in the 21st Century: Diagnostic and Treatment Issues
2012Co-Authors: Mario A. Cristancho, John P. O’reardon, Michael E ThaseAbstract:Identification of Atypical features is important in the treatment of Depression for both treatment selection and prognosis, especially when initial measures prove ineffective. The concept of Atypical Depression has evolved over many years, and now it appears timely for a further revision.
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Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria
Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 2009Co-Authors: Michael E ThaseAbstract:Stewart et al (2009) have outlined the evidence in support of the validity of the DSM-IV definition of the ‘With Atypical Features’ episode specifier. Although recognizing the historical significance and clinical utility of the concept of Atypical Depression, this article takes issue with the DSM-IV criteria. It is concluded that mood reactivity, the A or obligative criterion, is neither significantly associated with the other symptomatic criteria nor useful to diagnose Atypical Depression, and thus should be eliminated. Problems with operationalization, specification, and reliability of ratings of the diagnostic criteria further limit validity. Despite these limitations in classification, many of the features associated with Atypical Depression are linked to an early onset of affective illness, including trait-like interpersonal sensitivity, comorbid social anxiety and agoraphobia, a history of childhood physical or sexual trauma, and indicators of the ‘soft’ side of the bipolar spectrum. Neurophysiologic studies also suggest that chronic, early-onset Atypical Depressions differ from both melancholia and normality. Re-analyses of the Columbia group's seminal studies suggest that preferential response to phenelzine vs imipramine—arguably the strongest validator of Atypical Depression—similarly appears to be limited to patients with chronic, early-onset syndromes. The criteria for Atypical Depression need to be revised in DSM-V, including sharpening the operational definitions for the specific symptoms. The importance of age of onset and comorbid anxiety warrant further study. Research examining the validity of a subform of Atypical Depression characterized by trait-like interpersonal sensitivity and a chronic, early-onset course may further enhance the clinical utility of the DSM-V classification.
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Atypical Depression: a valid subtype?
The Journal of clinical psychiatry, 2007Co-Authors: Gordon Parker, Michael E ThaseAbstract:The concept of Atypical Depression emerged in the 1950s to describe individuals who experienced unusual characteristics of Depression and responded better to treatment with monoamine oxidase inhibitors than with tricyclic antidepressants. Over the next 50 years, research refined the criteria for Atypical Depression, which led to the establishment of the criteria outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. These criteria, however, appear to be in need of revision. Newer research downplays the role of mood reactivity and instead emphasizes rejection sensitivity. Atypical Depression appears to be a multiaxial condition that ranges across Axis I symptom states to Axis II personality styles, is a nonmelancholic spectrum disorder, and is associated with self-consolatory strategies that are homeostatic and symptomatic.
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A History of the Concept of Atypical Depression
The Journal of clinical psychiatry, 2007Co-Authors: Jonathan R. T. Davidson, Michael E ThaseAbstract:The term Atypical Depression as a preferentially monoamine oxidase inhibitor (MAOI)-responsive state was first introduced by West and Dally in 1959. Further characterization of this syndrome and its responsiveness to antidepressants came to occupy the attention of many psychopharmacologists for the next 30 years. Different portrayals of Atypical Depression have emerged, for example, nonendogenous Depression, phobic anxiety with secondary Depression, vegetative reversal, rejection-sensitivity, and Depression with severe chronic pain. Consistency across or within types has been unimpressive, and no coherent single type of Depression can yet be said to be "Atypical." In successfully demonstrating superiority of MAOI drugs to tricyclics, the Columbia (or DSM-IV) criteria have established their utility and become widely adopted, but other criteria have also passed this test. In this "post-MAOI" era, no novel compound or group of drugs has been clearly shown to have good efficacy in Atypical Depression, leaving the treatment of Atypical Depression as an unmet need.
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Introduction: new directions in the treatment of Atypical Depression.
The Journal of Clinical Psychiatry, 2007Co-Authors: Michael E ThaseAbstract:From the Department of Psychiatry, University of Pittsburgh Medical Center School of Medicine, and the Western Psychiatric Institute and Clinic, Pittsburgh, Pa. This article is derived from the planning roundtable “Atypical Depression: Management Challenges and New Treatment Advances,” which was held July 22, 2006, in Philadelphia, Pa., and supported by an educational grant from Bristol-Myers Squibb Company. Corresponding author and reprints: Michael E. Thase, M.D., Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213 (e-mail: thaseme@upmc.edu). n this supplement, each article focuses on a different aspect of Atypical Depression. First, Jonathan R. T. I Davidson, M.D., examines the evolution of the concept of Atypical Depression; second, Gordon B. Parker, M.D., Ph.D., D.Sc., discusses the validity of the current concept and suggests a new model for viewing Atypical Depression from a personality spectrum perspective; third, Jonathan W. Stewart, M.D., presents a review of the treatment literature, focusing on established therapies and ending with the work on selective serotonin reuptake inhibitors (SSRIs); and finally, Mark H. Rapaport, M.D., considers newer perspectives on treatment of Atypical Depression and evaluates recent therapy developments. This brief overview touches on the topics that each author addresses.
