Abstract
ObjectiveTo assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients and to determine if melancholic and atypical depression can be differentiated from residual non-melancholic depressive conditions.Subjects/Materials and MethodA prospective, naturalistic, multicentre, nationwide epidemiological study of 1455 depressive outpatients was undertaken. Severity of depressive symptoms was assessed by the Hamilton Depression Rating Scale (HDRS) and the Self Rated Inventory of Depressive Symptomatology (IDS-SR30). IDS-SR30 defines melancholic and atypical depression according to DSM-IV criteria. Assessments were carried out after 6–8 weeks of antidepressant treatment and after 14–20 weeks of continuation treatment.ResultsMelancholic patients (16.2%) were more severely depressed, had more depressive episodes and shorter episode duration than atypical (24.7%) and non-melancholic patients. Atypical depressive patients showed higher rates of co-morbid anxiety disorders and substance abuse. Melancholic patients showed lower rates of remission.ConclusionOur study supports a different clinical pattern and treatment outcome for melancholic and atypical depression subtypes.
Highlights
The broad heterogeneity of clinical depression has long encouraged research seeking to identify depressive subtypes that show causal, and even more importantly, treatment specificity [1,2]
The naturalistic design of the present study provides an opportunity to assess sociodemographic, clinical and treatment factors as well as depression outcome in a large representative clinical sample of psychiatric depressive outpatients, to determine if melancholic and atypical depression can be positioned as distinctive clinical entities
Sociodemographic variables Final analyses were undertaken on 1455 subjects
Summary
The broad heterogeneity of clinical depression has long encouraged research seeking to identify depressive subtypes that show causal, and even more importantly, treatment specificity [1,2]. Differing options for future DSM depressive categories include weighting depressive sub-types, as against providing specifiers for major depressive episodes or distinct qualitative affective disorders [1,4,5,8,9,10,11,12]. Melancholic depression affects about 25–30% of depressive populations [13,14] and is clinically characterized by distinct quality of mood, non-reactivity of mood to circumstances, anhedonia, psychomotor disturbance, cognitive impairment and symptoms of vegetative dysfunction such as terminal insomnia, diurnal mood variation with worsening in the morning and weight loss [7,15]. Depressive patients with melancholic features have worse outcomes and reduced probability of remission from major depressive disorder compared to those with non-melancholic depression [18]. Some authors have argued that melancholia is a disease entity on the basis of its psychopathology, biology and differential response to treatment [12] and have proposed new diagnostic criteria [4]
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