Is duloxetine effective treatment for depression with atypical features?

Depression with atypical features responds preferentially to monoamine oxidase inhibitors relative to tricyclic antidepressants. The efficacies of newer agents have been little studied in this group, although fluoxetine was more effective than placebo. Studies with newer agents seem indicated. Twenty outpatients having major depression with atypical features were treated for 8 weeks with up to 120 mg/day of duloxetine. Fifty percent responded (>50% decrease in 24-item Hamilton Rating Scale for Depression) and 35% remitted (final 24-item Hamilton Rating Scale for Depression < or =7). The small sample size results in wide confidence intervals and lack of a placebo control group limits inferences of efficacy. Response and remission rates for depressed patients with atypical depression were similar to those reported for depressed patients in general. Placebo-controlled studies are required to definitively demonstrate whether these pilot results represent the efficacy of duloxetine in treating atypical depression.