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Identification of Depression with Atypical Features



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Am Fam Physician. 2004 Feb 15;69(4):973-978.

The term “atypical depression” has been used to describe a type of depression that has a unique symptom profile and responds differently to medications. Patients with atypical depression tend to respond better to treatment with monoamine oxidase inhibitors than to treatment with tricyclic antidepressants. The Columbia criteria were developed to help physicians diagnose atypical depression. These criteria for atypical depression include a major depressive disorder with mood reactivity. This mood reactivity is accompanied by any two of the following symptoms: hypersomnia, increased appetite or weight gain, leaden paralysis, and rejection sensitivity. These criteria also have been included in the nomenclature to specify a major depressive episode of a major depressive disorder and bipolar mood disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. However, recent studies have suggested that vegetative symptoms (i.e., hypersomnia and hyperphagia) are better markers for atypical depression and can be used easily to identify patients with atypical depression. Matza and associates identified patients with atypical depression, based on the vegetative symptoms of hypersomnia and hyperphagia, and compared this group with a group who had typical depression and a group who had no psychiatric disorder.

The authors obtained the study population from the U.S. National Comorbidity Survey. The survey was performed on a selected sample of persons 15 to 54 years of age and was a structured, face-to-face interview in each participant's home using the Composite International Diagnostic Interview in two parts. Part 1 included diagnostic assessment and was administered to 8,098 persons, while part 2 was designed to assess the consequences of psychiatric disorders and was administered to 5,877 persons. Atypical depression was based on the finding of symptoms consistent with depression, hypersomnia, and hyperphagia. Additional characteristics assessed during the study included demographics, comorbid psychiatric disorders, depressive symptoms, use of health care services, history of abuse and parental depression, and disability and restricted-activity days.

Of the study participants, 304 met the criteria for atypical depression, and 532 had typical depression. The atypical depression group included more women, and participants developed depression at an earlier age than those in the typical depression group. The atypical group also reported significantly higher rates of most depressive symptoms, suicidal thoughts and attempts, psychiatric comorbidities, disability and restricted-activity days, use of health care services, parental depression, and childhood neglect and abuse. In addition, the atypical depression group had significantly higher rates of disability and restricted-activity days, use of mental health care services, parental depression, and childhood neglect or abuse compared with the group that had no history of psychiatric disorders.

The authors conclude that the symptoms of overeating and oversleeping can be used to identify patients with atypical depression. These patients are distinct when compared with patients who have typical depression. The use of these two symptoms may be an accurate screening strategy for identifying atypical depression in general practice settings.

Matza LS, et al. Depression with atypical features in the National Comorbidity Survey. Classification, description, and consequences. Arch Gen Psychiatry. August 2003;60:817–26.


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