Atypical Depression

A series of studies by the Columbia University Group examined the efficacy of imipramine in depressed patients with atypical features (Liebowitz et al. 1984, 1988). These depressed patients had reactive mood and reversed vegetative symptoms, severe fatigue, or rejection sensitivity. Imipramine was more effective than placebo but significantly less effective than the monoamine oxidase inhibitor (MAOI) phenelzine. Other investigators have reported the value of switching from a tricyclic to an MAOI in tricyclic-refractory depressed patients, especially those with atypical features (McGrath et al. 1987; Thase et al. 1992). In fact, the validity and utility of the atypical subtype of depression were in large part supported by this observed difference. However, this subtype has not been shown to be preferentially responsive to SSRIs (Fava et al. 1997), nor has any second-generation antidepressant been shown to be superior to any other in treating atypical depression.

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