Conclusion/Depression and Its Subtypes: A Treatment Update

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In this Supplement, Andrew A. Nierenberg, M.D., hasreviewed the large body of clinical trials that havedemonstrated a specific pharmacologic response for thedepressive subtype termed atypical depression, defined bythe presence of mood reactivity combined with 2 of thefollowing: hypersomnia, hyperphagia, leaden paralysis,and/or rejection sensitivity. For patients with this profileof depressive symptoms, the monoamine oxidase inhibitor(MAOI) phenelzine proved superior to the tricyclic antidepressant(TCA) imipramine. The combination of a welldefinedsymptom profile and evidence of a preferential responseto one class of antidepressants over another givesimportant support to the impetus to identify subtypes ofpatients with major depression.