Testing early-onset chronic atypical depression subtype

Sir A recent paper in your journal (Stewart et al, 2002), about DSM-IV atypical depression (AD), showed that the typical better response to MAOI than to TCA was seen only in the early-onset

and chronic subtype, suggesting the need to better study this important subtype. The study aim was to find support for this subtyping of AD. A large database by the author, collected during

the last 5 years for other studies (so eliminating any interviewer bias), was scanned for such evidence. Study methods, briefly reported below, are fully explained in previous reports

(Benazzi, 1999, 2000a, 2000b, 2002a, 2002b, 2002c, 2003a,2003b). METHODS STUDY SETTING An outpatient psychiatry private practice, more representative of mood disorders usually seen in

clinical practice in Italy. INTERVIEWER A senior clinical and mood disorder research psychiatrist. PATIENTS Consecutive 320 bipolar-II (BP-II) and 243 major depressive disorder (MDD)

outpatients, presenting voluntarily for MDE treatment. Substance-related and borderline personality disorders were excluded because of confounding diagnosis of BP-II, and rare in the

setting. Clinically significant general medical illnesses and cognitive disorders were also excluded. INTERVIEW METHODS During the assessment visit (off psychoactive drugs for at least 2

weeks, apart from a few cases on small doses of benzodiazepines), the following instruments were used: (1) Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version

(SCID-CV) (First et al, 1997). (2) Global Assessment of Functioning scale (GAF, in SCID-CV) for index MDE severity. (3) Family History Screen (Weissman et al, 2000). Often, family

members/close friends supplemented clinical information during interview. DSM-IV criteria for MDE with atypical features specifier (AD) were followed. ‘Early onset’ was defined as the onset

of first MDE before age 21 years (according to Stewart et al, 2002), ‘chronic’ as index MDE symptoms lasting more than 2 years. Variables often reported to distinguish atypical _vs_

nonatypical depression were assessed (see references by Benazzi, Agosti and Stewart, 2001; Angst et al, 2002; Matza et al, 2003 and Rabkin et al, 1996). Early-onset chronic AD (EO-C-AD) was

compared to nonearly-onset, nonchronic AD (non-EO-C-AD). STATISTICS Logistic regression was used to study associations and to control for confounding and interactions (STATA 7). _P_-values

were two-tailed, _α_ level 0.05. RESULTS AD was present in 44.5% (251/563). EO-C-AD was present in 26.2% of AD (66/251). In the AD sample, univariate logistic regression of EO-C-AD _vs_

BP-II, index age, female gender, recurrences, axis I comorbidity, GAF, bipolar family history, DSM-IV atypical symptoms, found significantly associated BP-II (odds ratio=2.2, 95%

CI=1.2–4.0), age (odds ratio=0.9, 95% CI=0.9–0.9), more recurrences (odds ratio=4.4, 95% CI=2.3–8.3), more axis I comorbidity (odds ratio=2.4, 95% CI=1.4–4.4), more bipolar (I+II) family

history (odds ratio=2.9, 95% CI=1.4–5.9), and hypersomnia (odds ratio=1.8, 95% CI=1.0–3.2). Multivariate logistic regression of EO-C-AD _vs_ variables found significant in the univariate

analysis (not including age), including all possible interactions, found that recurrences (odds ratio=4.3, 95% CI=1.8–10.0), axis I comorbidity (odds ratio=2.4, 95% CI=1.2–5.1), bipolar

family history (odds ratio=2.7, 95% CI=1.2–6.1), and hypersomnia (odds ratio=2.5, 95% CI=1.1–5.3) were still significant and independently associated. DISCUSSION Findings support, on

clinical and family history grounds, a distinction between EO-C-AD and non-EO-C-AD. The findings support the pharmacological distinction found by Stewart et al (2002). REFERENCES * Agosti V,

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AUTHORS AND AFFILIATIONS * E Hecker Outpatient Psychiatry Center, Ravenna, Italy Franco Benazzi * Department of Psychology, University of Bologna, Bologna, Italy Franco Benazzi * Department

of Psychiatry, National Health Service, Forli, Italy Franco Benazzi Authors * Franco Benazzi View author publications You can also search for this author inPubMed Google Scholar

CORRESPONDING AUTHOR Correspondence to Franco Benazzi. RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Benazzi, F. Testing Early-Onset Chronic Atypical

Depression Subtype. _Neuropsychopharmacol_ 29, 440–441 (2004). https://doi.org/10.1038/sj.npp.1300355 Download citation * Received: 24 August 2003 * Accepted: 16 October 2003 * Published: 20

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