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		A PUBLICATION OF CME OUTFITTERS	VOLUME 1, ISSUE 27, November 21, 2006
		FROM THE CLINICAL KNOWLEDGE CENTER Evidence for New Treatment Options in Atypical Depression Atypical depression, the most common subtype of depression seen in outpatients, is distinct from other types of depression in terms of psychiatric symptom profile and treatment response. However, compared with melancholia, little is known about its comorbidity, course, and treatment. This knowledge gap fuels continuing debate regarding its specific characteristics, impact, and diagnostic criteria. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) lists the following features for atypical depression: A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events) B. Two (or more) of the following features: 1. significant weight gain or increase in appetite 2. hypersomnia 3. leaden paralysis (i.e., heavy, leaden feelings in arms or legs) 4. long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment Atypical depression has an estimated 1-year prevalence of approximately 1%-4%, accounting for a 20%-25% share of major depressive episodes. The atypical subtype is notable for its earlier onset, more chronic course, and especially high rates of comorbidity with social phobia, dysthymic disorder, bipolar II, and panic disorder with agoraphobia, as well as a higher incidence in women. Emerging data demonstrate that novel delivery of monoamine oxidase inhibitors (MAOIs) may be more effective in treating atypical depression than other medications, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). You are invited to join Charles Nemeroff, MD, PhD, and Michael Thase, MD, in a case-based educational activity that explores novel treatment strategies in the management of atypical depression. Click HERE to register. Resources Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: Amer Psychiatric Assoc;1994. Posternak MA, Zimmerman M. Partial validation of the atypical features subtype of major depressive disorder. Arch Gen Psychiatry 2002;59:70-76. Nierenberg AA, Alpert JE, Pava J, Rosenbaum JF, Fava M. Course and treatment of atypical depression. J Clin Psychiatry 1998;59(Suppl 18):5-9. Quitkin K. Depression with atypical features: diagnostic validity, prevalence, and treatment. Primary Care Companion J Clin Psychiatry 2002;4:94-99. Thase ME, Trivedi MH, Rush AJ. MAOIs in the contemporary treatment of depression. Neuropsychopharmacology 1995;12:185-219.
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