Conclusion: Depression and Its Subtypes: A Treatment Update

In this Supplement, Andrew A. Nierenberg, M.D., has reviewed the large body of clinical trials that have demonstrated a specific pharmacologic response for the depressive subtype termed atypical depression, defined by the presence of mood reactivity combined with 2 of the following: hypersomnia, hyperphagia, leaden paralysis,and/or rejection sensitivity. For patients with this profile of depressive symptoms, the monoamine oxidase inhibitor (MAOI) phenelzine proved superior to the tricyclic antidepressant (TCA) imipramine. The combination of a well-defined symptom profile and evidence of a preferential response to one class of antidepressants over another gives important support to the impetus to identify subtypes of patients with major depression. These findings for atypical depression were perhaps more impressive, given that patients with the atypical profile were at one time those most likely to be viewed as characterological and less well suited to a pharmacotherapeutic as opposed to psychotherapeutic intervention.