Atypical signs of relapse in affective disorders

The authors have observed that patients with previous well documented evidence of affective illness can have an atypical relapse of depression precipitated by environmental or interpersonal stress. These patients present with complaints centered around problems resulting from current life stress. They deny sad mood and resist the idea that they are having recurrence of depression. It is suggested that the presence of anhedonia be used as a clinical guide to differentiate "understandable" preoccupation with reality problems from emergent depressive relapse. Patients with atypical relapses respond to antidepressants with a disappearance of anhedonia and an ability to place realistic problems in their proper perspective. Cases are presented illustrating this phenomena.