Atypical Depressive Symptoms Research Articles

Critical stenosis left main coronary artery in 39-year-old woman treated with percutaneous angioplasty

Isolated critical stenosis of left main coronary artery (LMCA) due to atherosclerosis is very rare and affects about 0.2% of patients. We present the case of a 39-year-old, non-smoker women with risk factors for diseases of the cardiovascular system in the form of hypercholesterolaemia and hypertension, in addition to positive family history and chronic oral contraception. Sick from occurring since atypical angina masked depressive symptoms, with a critical stenosis of LMCA and little suggestive symptoms of ischaemia because of the existing collateral circulation.

Serotonin: Vital affects and psychotherapy

Including biological measures such as the serotonin function to the outcome variables of psychotherapy opens novel perspectives, which may enable better integration of diagnostic and neurobiological aspects with psychotherapy research. However, the problems of epistemology, ontology and the conceptual differences pertaining to such interdisciplinary efforts have to be adequately considered in order to avoid confusion between the different explanatory models used in neurobiological and clinical psychotherapy research. A number of studies have already shown that psychotherapy can be connected with significant changes in the function of brain networks. Recently, preliminary evidence has been gained that also changes in the synaptic transmission in serotonin pathways may take place during the psychotherapy of patients with depression. Although these findings have to be repeated and confirmed in future research with larger patient samples, it seems likely that in selected individuals, especially in those with atypical symptoms of depression, the reduced serotonin function can be normalized during psychotherapy.

The predictive validity of atypical neurovegetative depressive symptoms identified by the first principal component in the DUAG trial of moclobemide versus clomipramine

To investigate to what extent the primary depression subtype atypical depression can predict differential outcome of the mono-amino-oxidase inhibitor (MAO-I) moclobemide and the tricyclic antidepressant clomipramine in the Danish University Antidepressant Group Study (DUAG). In a randomised, double blind trial, a total of 117 patients with major depression were treated over 6 weeks with either 400 mg moclobemide or 150 mg clomipramine. A baseline principal component analysis (PCA) was performed to identify atypical symptoms on the combined depression scales (Hamilton Depression Scale (HAM-D(17)) and the Quantitative Scale for Atypical Depression (QSAD)). The primary outcome scale was the subscale HAM-D(6) which contains the pure items of depression. PCA identified two items with loadings opposite to the other depression items within HAM-D(17) and QSAD, namely increased duration of sleep and increased appetite (atypical neurovegetative symptoms). Patients with a positive score at baseline on these items were classified as having atypical depression. In total 13 patients were classified as having atypical depression. Within this group of patients 8 received clomipramine and 5 patients received moclobemide. At endpoint the moclobemide treated patients had a significantly better response than the clomipramine treated (P=0.036), effect size 1.42, when using HAM-D(6) as outcome. However, in the 104 patients classified as having typical depression clomipramine was superior to moclobemide (P=0.034), effect size 0.47. The number of patients with atypical neurovegetative symptoms was very small and no placebo arm was included. It is very important to screen for atypical depression (increased duration of sleep/increased appetite) in the acute therapy of patients with major depression. Our results add to the body of evidence that monoamine oxidase inhibitors are superior to tricyclic antidepressants in this sub-group of patients.

P-204 - Clinical features of bipolar depression versus unipolar depression: a preliminary study

Depressive episodes in bipolar type I, II and unipolar disorder have many common traits, but also differences. Failing to diagnose bipolar disorder in patients who are in a severe depressive episode can lead to unfortunate treatment options and a poor outcome. Identifying differences in clinical features of bipolar and unipolar depression. Identifying clinical features that distinguish bipolar from unipolar depression will allow better treatment options, improve the outcome and the quality of life of the patients. The preliminary study is being conducted in Timisoara, Romania and consists of 76 in- and outpatients from the Timisoara Psychiatric Clinic and the Timisoara Mental Health Center, diagnosed with either bipolar type I, II or recurrent depressive disorder, according to ICD-10 criteria. 5 separate assessments will be made over a period of 20 months, comprising of a battery of assessment scales and tests, including neurocognitive assessments. The preliminary results show an association between the age of onset (earlier in bipolar depression), atypical depressive symptoms (more frequent in the bipolar group), number of depressive episodes (a higher number in the bipolar group), somatic symptoms (more frequent in the unipolar group) and cognitive functioning (less impared in the unipolar group). Initial results show that there are subtle differences in presentation between bipolar and unipolar depression and that these differences may help guide the initial diagnosis.

P-1302 - Relationship between metabolic syndrome and clinical features of schizophrenia

Objective The aim of this study was to evaluate the prevalence of metabolic syndrome and metabolic syndrome criteria in patients with schizophrenia and also to investigate the effects of metabolic syndrome on medical treatment, clinical course. Method One hundred-sixteen patients with schizophrenia were consecutively admitted. Waist circumference, blood pressure, body weight and height were measured, and body mass index was calculated. Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia were applied to the patients. Results The frequency of metabolic syndrome according to IDF criteria was 42.2% among the patients (46.9% for female and 38.8% for male patients). There was no significant difference between patients with and without metabolic syndrome in terms of age. The frequencies of metabolic syndrome were 62.5% for together taken typical and atypical antipsychotics and 35.7% for taken two or more atypical antipsychotics, whereas the rates of metabolic syndrome of taken only one atypical and only one typical antipsychotics were 45.1% and 13.3%, respectively. The duration of disease in patients with metabolic syndrome was higher than those without. Conclusion In this study, the frequency of metabolic syndrome in patients with schizophrenia was consistent with the results of previous studies in our country. Our findings showed that the duration of illness, high scores of BMI, use of clozapine or concurrent use of typical and atypical antipsychotics, depressive and negative symptoms of schizophrenia were significant risk factors.

P-189 - Clinical features of bipolar depression versus unipolar depression

To explore the difference in the clinical features between bipolar disorder and unipolar depression from the clinical phenomenology. Two hundred bipolar patients with their current depressive episode and five hundred and sixty three recurrent depression were involved in the study. Clinical features of these two groups were compared and stepwise Logistic regression was used to identify the relationship between clinical features and bipolar disorder. Clinical features of depressive episode which was different between two groups and were associated with bipolar disorder were as follows: age at onset of bipolar was earlier than that of unipolar depression; Bipolar patients whose age at onset before 25 years were more than unipolar depression; Sexual appetites which was one of atypical depressive symptoms were more common in bipolar depression than in unipolar depression; With psychiatric symptoms, psychomotor retardation, mood instability and duration of every depressive episode < 3 months, were more common in bipolar depression group than in unipolar depression group; Cognitive impairment factor, one of factors of HAMD-17 score, was significantly higher in bipolar depression group than in unipolar depression group. The odd ratio were 1.54, 1.50, 3.25, 1.99, 1.89, 1.48, 1.63, 1.63, and 1.42 separately. The founding suggested that unipolar depression and bipolar depression might be distinct disorder, and age at onset, age at onset < 25, sexual appetites, psychiatric symptoms, psychomotor retardation, mood instability and duration of every depressive episode < 3 months might be potential to be the predictors of bipolar disorder.

Obstruktives Schlaf-Apnoe-Syndrom als Ursache einer atypischen Depression

Sleep apnoea is a common disorder presenting with somatic comorbidities and psychiatric symptoms. This case report describes a 43-year-old man with an organic depressive disorder due to obstructive sleep apnoea. Initially, an atypical depressive episode or schizophrenic residual syndrome had been considered likely diagnoses; subsequent polysomnography results, however, suggested obstructive sleep apnoea instead. Upon nasal continuous positive airway pressure (nCPAP), the respiratory distress symptoms improved. The case report highlights the association between sleep disturbances and depressive symptoms. In patients presenting with symptoms of atypical depression and excess body weight sleep apnoea should be considered.

Mother-Infant Antidepressant Concentrations, Maternal Depression, and Perinatal Events

The authors explored the relationship of cord-maternal antidepressant concentration ratios and maternal depression with perinatal events and preterm birth. The investigators examined 21 mother-infant pairs that had antidepressant exposure during pregnancy. The antidepressants included serotonin reuptake inhibitors (SRIs) and nortriptyline (a norepinephrine inhibitor and mild SRI). The mothers were evaluated with the Structured Clinical Interview for DSM-IV. Depression ratings were repeated at 20, 30, and 36 weeks' pregnancy. At delivery, investigators assessed cord and maternal antidepressant concentrations, neonatal outcomes on the Peripartum Events Scale (PES), and gestational weeks at birth. The investigators performed this study at the Women's Behavioral HealthCARE Program, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pennsylvania, from April 2003 until September 2006. Mean ± SD cord-to-maternal concentration ratios were 0.52 ± 0.35 (range, 0.00-1.64) for the parent drug and 0.54 ± 0.17 (range, 0.28-0.79) for the metabolite. Nine of 21 mothers (43%) had a major depressive episode. From examining the maximum depression ratings, the mean ± SD Structured Interview Guide for the Hamilton Depression Rating Scale, Atypical Depression Symptoms Version score was 16.0 ± 7.6. One third (7/21) of infants had at least 1 perinatal event (PES ≥ 1). The frequency of deliveries complicated by any perinatal event was similar in depressed and nondepressed mothers. There was no significant association between perinatal events and cord-to-maternal antidepressant concentration ratios or maternal depression levels. Exposure to short half-life antidepressants compared to fluoxetine resulted in more perinatal events (7/16 = 44% vs 0/5 = 0%; P = .06). Fourteen percent (3/21) of infants were preterm. Preterm birth was not associated with cord-to-maternal metabolite concentration ratios, depression levels, or exposure to fluoxetine. Antidepressant-exposed infants experienced a limited number of transient perinatal events. No association between cord-maternal concentration ratios or maternal depression and perinatal events could be identified. Contrary to other reports, we detected no increased risk for perinatal events with fluoxetine therapy compared to the short half-life antidepressants. clinicaltrials.gov Identifier: NCT00279370.

Relationship of morningness–eveningness questionnaire score to melatonin and sleep timing, body mass index and atypical depressive symptoms in peri- and post-menopausal women

Previous work shows a relationship between measures of morning or evening preference (e.g., morningness–eveningness questionnaire (MEQ) scores) and melatonin and sleep timing, body mass index (BMI) and mood. This study explores the relationship of these factors to atypical depression (ATD) symptoms, particularly increased appetite and hypersomnia, in depressed and non-depressed peri- and post-menopausal women. Participants were 19 normal control subjects and 10 depressed patients, 46–72years of age. In a university hospital setting, we administered the MEQ and Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders (SIGH-SAD version), which includes a measure of ATD, 3–5weeks before obtaining nighttime polysomnography and overnight plasma melatonin in dim light (<30lx). Scores on SIGH-SAD appetite-related items were significantly correlated with MEQ, dim light melatonin onset (DLMO) time and midsleep time (MST); BMI was related to MST, sleep end time, phase-angle differences between sleep and melatonin timing, and appetite measures. Results suggest that relative to women with earlier DLMOs and MSTs, depressed peri- and post-menopausal women whose DLMOs and MSTs are phase-delayed may experience increases in appetite, hypersomnia, and BMI. These symptoms might be relieved by sleep or light manipulations that advance melatonin and sleep timing parameters.

Circadian rhythm and the phenotype of major depressive disorder

Middle East Current Psychiatry 2011, 18:29–36 Introduction For many years, researchers have suggested that abnormalities in circadian rhythms may underlie the development of mood disorders, such as major depression. The objectives behind this study were to investigate whether cortisol circadian rhythm could be considered as a biomarker for major depression, to identify whether different circadian rhythm alterations in patients with major depression is interrelated with syndrome presentation (either with or without psychotic features) and symptom profile (typical and atypical depressive symptoms) and to investigate whether there are alterations in the cortisol circadian rhythm and whether it could be a possible endophenotype among first-degree relatives of patients. Methods Fourteen patients, aged between 25 and 50 years, in a major depressive episode or in a depressed phase of bipolar disorder, six controls and six first-degree relatives were screened using psychometric questionnaires, and a blood sample was withdrawn from consenting participants at four time points during the day, for the assessment of plasma cortisol secretion. The patients were diagnosed by a clinical psychiatric interview and a semistructured psychiatric interview based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria for diagnosis, and a psychometric assessment was made. Serum cortisol levels were assayed using a validated commercial kit. Results There was a statistically significant difference between serum cortisol levels of the three studied groups at four consecutive sampling points over 24 h. The elevated plasma cortisol levels of patients correlated positively with phenotypic features, such as suicidality (P=0.029), positive family history of psychiatric disorder (P=0.024), chronotype of the patients (P=0.017) and their scores on Beck Depression Inventory (P=0.029) and Hamilton Depression Rating Scale (P=0.05). In addition, there is no statistically significant difference between patients and their first-degree relatives on the scores of Bipolar Affective Disorder Dimension Scale. Conclusion The increase in cortisol secretion and shift in its circadian phase and chronotypes of depressed patients and their first-degree relatives suggest that cortisol level is probably a state marker in mood disorder. In addition, different phenomenology and symptomatology of depression was closely interrelated to cortisol levels. Further genetic studies are recommended to establish its predictive significance.

Nosology, Diagnostic Challenges, and Unmet Needs in Managing Bipolar Disorder

The spectrum of bipolar disorders includes the subtypes of bipolar I disorder, bipolar II disorder, cyclothymic disorder, and bipolar disorder not otherwise specified (NOS). Because depression is the most pervasive symptom of bipolar disorder, this condition is frequently misdiagnosed as unipolar major depressive disorder. As a result, patients often experience substantive delays in receiving the correct diagnosis and appropriate treatment. To help meet this important diagnostic challenge, various markers have been identified that have predictive value for a bipolar outcome, including early onset of depression, family history of bipolar disorder, atypical depressive symptoms, and the presence of psychosis. Unmet needs in the management of bipolar disorder include an enhanced diagnostic process, more options for treating bipolar depressive episodes, and safer, more tolerable medications for long-term maintenance treatment.

The DSM IV diagnoses of melancholic and atypical depression in pregnancy

Atypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy. A modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non-depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical or non specified depression, and those without depression. Seventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4% and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate. Differential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.

Uzmanlaşmış bir merkezde izlem iki uçlu depresyon belirti sayısını ve şiddetini etkiler mi?

Does follow-up in a specialized center influence symptom profile and severity of bipolar depression? Introduction: Despite bipolar patients spend up to one third of their lives in depression, the treatment of bipolar depression remains as an understudied area. Although more atypical depressive symptoms are expected to be seen in bipolar depression, ethnocultural differences and regular follow-ups can change the onset and expression of clinical symptoms. Thus, in the present study, we aimed to evaluate the symptoms of depressive bipolar patients who are followed up in a specialized mood disorder unit. Methods: The most severe depressive symptoms of 144 bipolar patients were followed up using standardized forms in a specialized mood disorder outpatient unit. Obtained data analyzed by descriptive statistics. Results: It was determined that less than 10% of depressive symptoms were severe. Feelings of guilt and low self-esteem were not detected in nearly half of the patients (45,8%); active (3,5%) or passive (15,3%) suicidal ideation was seen approximately in one-fifth of the patients. The rate of psychotic symptoms was considerably low (4,2%). Beside this, vegetative symptoms other than loss of energy and lack of concentration were not seen in more than half of the patients. Adding a mood stabilizer or titrating the levels and psychotherapeutic interventions were adequate for remission in one-third of the patients. Discussion: Although previously it was reported bipolar depressive symptoms were severe with higher suicide rates, in less than 10% of patients, depressive symptoms were severe and the rate of active suicidal ideation was 3,5% in our study. Moreover, the rate of psychotic symptoms was found 4,2%. Although occurrence of milder symptoms contradicts with the literature, this can be explained by the follow-up of the patients in a specialized unit and early intervention before symptoms get more severe. Decreased need for pharmacological intervention can also be explained by the same reason.

Does follow-up in a specialized center influence symptom profile and severity of bipolar depression?

Does follow-up in a specialized center influence symptom profile and severity of bipolar depression? Introduction: Despite bipolar patients spend up to one third of their lives in depression, the treatment of bipolar depression remains as an understudied area. Although more atypical depressive symptoms are expected to be seen in bipolar depression, ethnocultural differences and regular follow-ups can change the onset and expression of clinical symptoms. Thus, in the present study, we aimed to evaluate the symptoms of depressive bipolar patients who are followed up in a specialized mood disorder unit. Methods: The most severe depressive symptoms of 144 bipolar patients were followed up using standardized forms in a specialized mood disorder outpatient unit. Obtained data analyzed by descriptive statistics. Results: It was determined that less than 10% of depressive symptoms were severe. Feelings of guilt and low self-esteem were not detected in nearly half of the patients (45,8%); active (3,5%) or passive (15,3%) suicidal ideation was seen approximately in one-fifth of the patients. The rate of psychotic symptoms was considerably low (4,2%). Beside this, vegetative symptoms other than loss of energy and lack of concentration were not seen in more than half of the patients. Adding a mood stabilizer or titrating the levels and psychotherapeutic interventions were adequate for remission in one-third of the patients. Discussion: Although previously it was reported bipolar depressive symptoms were severe with higher suicide rates, in less than 10% of patients, depressive symptoms were severe and the rate of active suicidal ideation was 3,5% in our study. Moreover, the rate of psychotic symptoms was found 4,2%. Although occurrence of milder symptoms contradicts with the literature, this can be explained by the follow-up of the patients in a specialized unit and early intervention before symptoms get more severe. Decreased need for pharmacological intervention can also be explained by the same reason.

Manic symptoms in patients with depressive and/or anxiety disorders

Background Previous studies found that patients with depressive disorders frequently have lifetime manic symptoms or even an unrecognized bipolar disorder and that these patients have more severe illness. In this study we investigated whether the presence of significant manic symptoms among patients presenting with depressive and/or anxiety disorders is associated with more severe illness, more comorbidity, more suicidality and more atypical symptoms. Methods In a large cohort ( n = 2012) of persons with lifetime depressive and/or anxiety disorders (as confirmed with the Composite International Diagnostic interview (CIDI)) we used the 15-item Mood Disorder Questionnaire (MDQ) to assess the presence of lifetime manic symptoms. Patients with clinically recognized bipolar disorders were excluded from the study. Results Lifetime manic symptoms were present among 6.3% of the persons with depressive or anxiety disorders. Persons with lifetime manic symptoms more frequently had comorbid social phobia, generalized anxiety disorder and alcohol dependence, more frequently reported previous serious suicide attempts and their current depressive symptoms were more severe. Atypical depression symptoms were not more prevalent in persons with lifetime manic symptoms. Limitations The presence of a lifetime manic or hypomanic episode was not assessed with the CIDI. Conclusions Identifying lifetime manic symptoms with the MDQ in persons presenting with (unipolar) depressive or anxiety disorders, can not only help the recognition of actual bipolar disorder (as described in previous studies), but also the identification of a subgroup of patients with more severe symptomatology, more comorbid anxiety and alcohol dependence disorders, and more suicidality.

P01-391 - The diagnosis of melancholic and atypical depression during pregnancy

IntroductionAtypical and melancholic subtypes of depression based on the Diagnostic and Statistical Manual (DSM) IV are important concepts, especially for biological psychiatry. The aim of this study was to determine whether the symptoms used for the diagnoses of atypical and melancholic depression can distinguish these subtypes during pregnancy.MethodA modified version of the Structured Clinical Interview for DSM IV (SCID interview) was used that allowed assessment of all DSM IV symptoms of melancholic and atypical depression with depressed and non depressed women in pregnancy. A Swiss cohort of 449 women was interviewed. Four diagnostic groups were compared: women with melancholic, atypical, or non specified depression, and those without depression.ResultsSeventeen per cent of the cohort met SCID criteria for a depressive episode of depression at least once in pregnancy, with melancholic depression 2.4%, atypical depression 4.4%, and non specified depression 10.2%. Many of the symptoms used to distinguish atypical and melancholic depression did not discriminate between these groups during pregnancy. However some, such as mood reactivity, distinct quality of mood and sleep pattern, did discriminate.ConclusionsDifferential diagnosis between melancholic and atypical depression in pregnancy needs to be based on pregnancy specific definitions. The possible therapeutic consequences and the neurobiological basis for these findings warrant further research.

Best Practices: An Emerging Best Practice Model for Perinatal Depression Care

Best Practices: An Emerging Best Practice Model for Perinatal Depression Care

Symptoms of epilepsy and organic brain dysfunctions in patients with acute, brief depression combined with other fluctuating psychiatric symptoms: a controlled study from an acute psychiatric department

BackgroundIn psychiatric acute departments some patients present with brief depressive periods accompanied with fluctuating arrays of other psychiatric symptoms like psychosis, panic or mania. For the purpose of the present study we call this condition Acute Unstable Depressive Syndrome (AUDS).The aims of the present study were to compare clinical signs of organic brain dysfunctions and epilepsy in patients with AUDS and Major Depressive Episode (MDE).MethodsOut of 1038 consecutive patients admitted to a psychiatric acute ward, 16 patients with AUDS and 16 age- and gender-matched MDE patients were included in the study. Using standardized instruments and methods we recorded clinical data, EEG and MRI.ResultsA history of epileptic seizures and pathologic EEG activity was more common in the AUDS group than in the MDE group (seizures, n = 6 vs. 0, p = 0.018; pathologic EEG activity, n = 8 vs. 1, p = 0.015). Five patients in the AUDS group were diagnosed as having epilepsy, whereas none of those with MDE had epilepsy (p = 0.043). There were no differences between the groups regarding pathological findings in neurological bedside examination and cerebral MRI investigation.ConclusionCompared to patients admitted with mood symptoms fulfilling DSM 4 criteria of a major depressive disorder, short-lasting atypical depressive symptoms seem to be associated with a high frequency of epileptic and pathologic EEG activity in patients admitted to psychiatric acute departments.Trial registrationNCT00201474

Depressive symptoms and atypical jobs in France, from the 2003 Decennial health survey

The objective is to study the relations between depressive symptoms and atypical jobs in the working population in France and to determine if these associations might be linked with psychosocial and organizational constraints. The data come from the 2003 Decennial health survey and concern 11,895 workers. Depressive symptoms were measured by the CES-D scale. Atypical jobs were defined by employment status (fixed-term or temporary job contract, permanent job contract, self-employed) and by part-time work during working life (involuntary or chosen). Working conditions related to atypical hours and psychosocial factors were also studied. For both sexes, involuntary part-time work was associated with a higher frequency of depressive symptoms, but part-time work by choice was not. Fixed-term contracts were associated with depressive symptoms only in women. All of these associations persisted after adjustment for psychosocial and organizational factors. The associations between atypical jobs and depressive symptoms differ for job status according to sex and do not seem to be associated with the worst psychosocial working conditions. The interpretation of these results is nonetheless limited in part by the cross-sectional nature of the survey.

Clinical correlates of atypical depression and validation of the French version of the Scale for Atypical Symptoms (SAS)

Background The 8-item “Scale for Atypical Symptoms” (SAS) and its structured interview, the SIGH-SAD, have been developed to assess atypical symptoms of depression in winter depression. Although they are commonly used, no validation study has yet been conducted. Methods 270 consecutive depressed inpatients were assessed prospectively. Pearson's correlation coefficients between fulfilment of Liebowitz criteria for atypical depression and both the SAS score and the atypical balance [ratio of the AS score to the total score on the Hamilton Depression Rating Scale 29-item (HDRS-29)] were calculated. The SAS was evaluated against Liebowitz criteria using binary logistic regression. A ROC curve was performed with the atypical balance against the fulfilment of Liebowitz criteria. Results 18.5% of patients met the criteria for atypical depression. The presence of an atypical depression was significantly correlated with both the atypical score ( r = 0.42) and the atypical balance ( r = 0.51). The logistic regression showed that a higher score on the SAS, the absence of a somatic syndrome (ICD-10) and a lower HDRS-21 score were independent predictors of an atypical depression while age, gender and bipolarity were not. The ROC curve showed that an atypical balance of 29% was the optimal threshold for the diagnosis of atypical depression (sensitivity = 0.86, specificity = 0.79). Limitation Patients with bipolar I and II were not distinguished. Conclusion Atypical depression is relatively frequent in hospitalised patients. The concurrent validity of the French version of the SAS and its structured interview, the SIGH-SAD is satisfactory.