Atypical depression: Australian and US studies in accord

A 2004 review of 'atypical depression' in Current Opinion in Psychiatry could be read as more reifying the Columbian and DSM-IV concept rather than considering an alternative model that has been supported by independent studies undertaken in Australia and North America. Additional analyses of the Australian data set are reported to examine inter-study agreement further and to consider the implications.

Both studies recruited patients meeting criteria for a major depressive episode, and then contrasted patients meeting or not meeting DSM-IV criteria for definite atypical depression. In both studies, those with atypical depression were comparable in terms of female preponderance, age, age at first episode and depression severity, but developed earlier and more persistent episodes, showed a slight female preponderance, and were more likely to meet criteria for panic disorder, social phobia and hypochondriasis, and of avoidant and dependent personality styles. In both, there was a lack of evidence suggesting that atypical depression differs in severity, in being clearly less likely to have certain 'endogeneity' symptoms, or in being more likely to be associated with bipolar disorder, while neither the centrality of mood reactivity nor interdependence of symptoms could be demonstrated.

Findings from both studies challenge the view that atypical depression is an entity and the current model of its constituent features. Both found support for primacy of personality style (rather than mood reactivity) and for certain expressions of anxiety. Both effectively argue for and assist shaping of a revisionist model for conceptualizing atypical depression as a syndrome or spectrum disorder.