Journal of Affective Disorders
Volume 84, Issue 2 , Pages 209-217 , February 2005

Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II?

  • Hagop S. Akiskal

      Affiliations

    • International Mood Center, University of California at San Diego, V.A. Hospital, 3350 La Jolla Village Dr. 116-A, La Jolla, San Diego, CA 92161, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1 858 552 8585x2226; fax: +1 858 534 8598.
  • ,
  • Franco Benazzi

      Affiliations

    • E. Hecker Outpatient Psychiatry Center, Ravenna, Italy
    • National Health Service, Forli, Italy

Received 10 February 2004 ,Accepted 13 July 2004.

References 

  1. Agosti V, Stewart JW. Atypical and non-atypical subtypes of depression: comparison of social functioning, symptoms, course of illness, co-morbidity and demographic features. J. Affect. Disord. 2001;65:75–79
  2. Akiskal HS. External validating criteria for psychiatric diagnosis: their application in affective disorders. J. Clin. Psychiatry. 1980;41:6–14
  3. Akiskal HS. The prevalent clinical spectrum of bipolar disorders: beyond DSM-IV. J. Clin. Psychopharmacol. 1996;16(Suppl. 1):4S–14S
  4. Akiskal HS. Soft bipolarity: a footnote to Kraepelin 100 years later. Jpn. J. Psychopathol. 2000;21:3–11
  5. Akiskal HS, Benazzi F. Family history validation of the bipolar nature of depressive mixed states. J. Affect. Disord. 2003;73:113–122
  6. Akiskal HS, Mallya G. Criteria for the “soft” bipolar spectrum: treatment implications. Psychopharmacol. Bull. 1987;23:68–73
  7. Akiskal HS, Djenderedjian AH, Rosenthal RH, Khani MK. Cyclothymic disorder: validating criteria for inclusion in the bipolar affective group. Am. J. Psychiatry. 1977;134:1227–1233
  8. Akiskal HS, Bitar AH, Puzantian VR, Rosenthal TL, Walker PW. The nosological status of neurotic depression: a prospective three-to-four year examination in light of the primary-secondary and unipolar–bipolar dichotomies. Arch. Gen. Psychiatry. 1978;35:756–766
  9. Akiskal HS, Khani MK, Scott-Strauss A. Cyclothymic temperamental disorders. Psychiatr. Clin. North Am. 1979;2:527–554
  10. Akiskal HS, Walker PW, Puzantian VR, King D, Rosenthal TL, Dranon M. Bipolar outcome in the course of depressive illness: phenomenologic, familial, and pharmacologic predictors. J. Affect. Disord. 1983;5:115–128
  11. Akiskal HS, Maser JD, Zeller P, Endicott J, Coryell W, Keller M, et al. Switching from unipolar to bipolar II: An 11-year prospective study of clinical and temperamental predictors in 559 patients. Arch. Gen. Psychiatry. 1995;52:114–123
  12. Akiskal HS, Bourgeois ML, Angst J, Post R, Moller H-J, Hirschfeld R. Re-evaluating the prevalence and diagnostic composition within the broad clinical spectrum of bipolar disorders. J. Affect. Disord. 2000;59(Suppl. 1):S5–S30
  13. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth edition. Washington, DC: American Psychiatric Association; 2000;Text Revision (DSM-IV-TR)
  14. Angst J, Gamma A, Sellaro R, Zhang H, Merikangas K. Toward validation of atypical depression in the community: results of the Zurich cohort study. J. Affect. Disord. 2002;72:125–138
  15. Angst J, Gamma A, Benazzi F, Ajdacic V, Eich D, Rossler W. Toward a re-definition of subthreshold bipolarity: epidemiology and proposed criteria for bipolar-II, minor bipolar disorders and hypomania. J. Affect. Disord. 2003;73:133–146
  16. Asnis GM, McGinn LK, Sanderson WC. Atypical depression: clinical aspects and noradrenergic function. Am. J. Psychiatry. 1995;152:31–36
  17. Benazzi F. Depression with DSM-IV atypical features: a marker for bipolar II disorder. Eur. Arch. Psychiatry Clin. Neurosci. 2000;250:53–55
  18. Benazzi F. Is 4 days the minimum duration of hypomania in bipolar II disorder?. Eur. Arch. Psychiatry Clin. Neurosci. 2001;251:32–34
  19. Benazzi F. Can only reversed vegetative symptoms define atypical depression?. Eur. Arch. Psychiatry Clin. Neurosci. 2002;252:288–293
  20. Benazzi F. Should mood reactivity be included in the DSM-IV atypical features specifier?. Eur. Arch. Psychiatry Clin. Neurosci. 2002;252:135–140
  21. Benazzi F. Frequency of bipolar spectrum in 111 private practice depression outpatients. Eur. Arch. Psychiatry Clin. Neurosci. 2003;253:203–208
  22. Benazzi F. Bipolar II disorder and major depressive disorder: continuity or discontinuity?. World J. Biol. Psychiatry. 2003;4:166–171
  23. Benazzi F. Diagnosis of bipolar II disorder: a comparison of structured versus semistructured interviews. Prog. Neuro-psychopharmacol. Biol. Psychiatry. 2003;27:985–991
  24. Benazzi F, Akiskal HS. Refining the evaluation of bipolar II: beyond the strict SCID-CV guidelines for hypomania. J. Affect. Disord. 2003;73:33–38
  25. Benazzi F, Akiskal HS. Setting the threshold for the duration of hypomania in the diagnosis of bipolar-II disorder. J. Affect. Disord. 2005;(in press)
  26. Brugha TS, Jenkins R, Taub N, Meltzer H, Bebbington PE. A general population comparison of the Composite International Diagnostic Interview (CIDI) and the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Psychol. Med. 2001;31:1001–1013
  27. Detre T, Himmelhoch J, Swartzburg M, Anderson CM, Byck R, Kupfer DJ. Hypersomnia and manic-depressive disease. Am. J. Psychiatry. 1972;128:1303–1305
  28. Dunner DL. Clinical consequences of under-recognized bipolar spectrum disorder. Bipolar Disord. 2003;5:456–464
  29. Dunner DL, Tay KL. Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression. Compr. Psychiatry. 1993;34:303–307
  30. Ebert D, Barocka A. The early course of atypical depression. Eur. Arch. Psychiatr. Neurol. Sci. 1991;241:131–132
  31. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version (SCID-CV). Washington, DC: American Psychiatric Press; 1997;
  32. Ghaemi SN, Ko JY, Goodwin FK. “Cade's disease” and beyond: misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. Can. J. Psychiatry. 2002;47:125–134
  33. Hantouche EG, Akiskal HS, Lencrenon S, Allilaire J-F, Sechter D, Azorin J-M, et al. Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a french national multi-site study (EPIDEP). J. Affect. Disord. 1998;50:163–173
  34. Hirschfeld RMA, Calabrese JR, Weissman MM, Reed M, Davies MA, Frye MA, et al. Screening for bipolar disorder in the community. J. Clin. Psychiatry. 2003;64:53–59
  35. Horwath E, Johnson J, Weissman MM, Horning CD. The validity of major depression with atypical features based on a community study. J. Affect. Disord. 1992;26:117–126
  36. Judd LL, Akiskal HS, Schettler PJ, Coryell W, Endicott J, Maser JD, et al. A prospective investigation of the natural history of the long-term weekly symptomatic status of bipolar II disorder. Arch. Gen. Psychiatry. 2003;60:261–269
  37. Kendell R, Jablensky A. Distinguishing between the validity and utility of psychiatric diagnoses. Am. J. Psychiatry. 2003;160:4–12
  38. Kendler KS. Toward a scientific psychiatric nosology. Strengths and limitations. Arch. Gen. Psychiatry. 1990;47:969–973
  39. Kendler KS, Eaves LJ, Walters EE, Neale MC, Heath AC, Kessler RC. The identification and validation of distinct depressive syndromes in a population-based sample of female twins. Arch. Gen. Psychiatry. 1996;53:391–399
  40. Kochman FJ, Hantouche EG, Ferrari P, Lancrenon S, Bayart D, Akiskal HS. The cyclothymic-sensitive temperament scale as a prospective predictor of bipolarity and suicidality in clinically depressed children and adolescents with major depressive disorder. J. Affect. Disord. 2005;in press
  41. Levitan RD, Lesage A, Parikh SV, Goering P, Kennedy SH. Reversed neurovegetative symptoms of depression: a community study of Ontario. Am. J. Psychiatry. 1997;154:934–940
  42. Matza LS, Revicki DA, Davidson JR, Stewart JW. Depression with atypical features in the national comorbidity survey. Arch. Gen. Psychiatry. 2003;60:817–826
  43. McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF. A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression. Am. J. Psychiatry. 2000;157:344–350
  44. McMahon FJ, Stine OC, Chase GA, Meyers DA, Simpson SG, DePaulo JR. Influence of clinical subtype, sex, and lineality on age at onset of major affective disorder in a family sample. Am. J. Psychiatry. 1994;151:210–215
  45. Mitchell PB, Wilhelm K, Parker G, Austin M-P, Rutgers P, Malhi GS. The clinical features of bipolar depression: a comparison with matched major depressive disorder patients. J. Clin. Psychiatry. 2001;62:212–216
  46. Nierenberg AA, Alpert JE, Pava J, Rosenbaum JF, Fava M. Course and treatment of atypical depression. J. Clin. Psychiatry. 1998;59(Suppl. 18):5–9
  47. Parker G, Roy K, Mitchell P, Wilhelm K, Malhi G, Hadzi-Pavlovic D. Atypical depression: a reappraisal. Am. J. Psychiatry. 2002;159:1470–1479
  48. Perugi G, Akiskal HS, Lattanzi L, Cecconi D, Mastrocinque C, Patronelli A, et al. The high prevalence of “soft” bipolar (II) features in atypical depression. Compr. Psychiatry. 1998;39:63–71
  49. Perugi G, Toni C, Travierso MC, Akiskal HS. The role of cyclothymia in atypical depression: toward a data-based reconceptualization of the borderline-bipolar II connection. J. Affect. Disord. 2003;73:87–98
  50. Posternak MA, Zimmerman M. Symptoms of atypical depression. Psychiatry Res. 2001;104:175–181
  51. Posternak MA, Zimmerman M. Partial validation of the atypical features subtype of major depressive disorder. Arch. Gen. Psychiatry. 2002;59:70–76
  52. Quitkin FM. Depression with atypical features: diagnostic validity, prevalence, and treatment. Prim. Care Companion J. Clin. Psychiatry. 2002;4:94–99
  53. Quitkin FM, McGrath PJ, Stewart JW, Klein DF. A reappraisal of atypical depression. Am. J. Psychiatry. 2003;160:798–800
  54. Rabkin JG, Stewart JW, Quitkin FM, McGrath PJ, Harrison WM, Klein DF. Should atypical depression be included in DSM-IV?. In: DSM-IV Sourcebook. vol. 2:Washington, DC: American Psychiatric Association; 1996;p. 239–260
  55. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am. J. Psychiatry. 1970;126:983–987
  56. Rothman KJ, Greenland S. Modern Epidemiology. 2nd ed.. Philadelphia: Lippincott Williams & Wilkins; 1998;
  57. Serretti A, Lattuada E, Cusin C, Macciardi F, Smeraldi E. Analysis of depressive symptomatology in mood disorders. Depress. Anxiety. 1998;8:80–85
  58. Simpson SG, McMahon FJ, McInnis MG, MacKinnon DF, Edwin D, Folstein SE, et al. Diagnostic reliability of bipolar II diagnosis. Arch. Gen. Psychiatry. 2002;59:736–740
  59. Sotsky SM, Simmens SJ. Pharmacotherapy response and diagnostic validity in atypical depression. J. Affect. Disord. 1999;54:237–247
  60. Sullivan PF, Kessler RC, Kendler KS. Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. Am. J. Psychiatry. 1998;155:1398–1406
  61. Sullivan PF, Prescott CA, Kendler KS. The subtypes of major depression in a twin registry. J. Affect. Disord. 2002;68:273–284
  62. Weissman MM, Wickramaratne P, Adams P, Wolk S, Verdeli H, Olfson M. Brief screening for family psychiatric history. The family history screen. Arch. Gen. Psychiatry. 2000;57:675–682
  63. Williams JBW, Terman M, Link MJ, Amira L, Rosenthal NE. Hypomania Interview Guide (Including Hyperthymia). Current Assessment Version (HIGH-C). Clinical Assessment Tools Packet. Norwood, NJ: Center for Environmental Therapeutics; 1994;
  64. Williamson DE, Birmaher B, Brent DA, Balach L, Dahl RE, Ryan ND. Atypical symptoms of depression in a sample of depressed child and adolescent outpatients. J. Am. Acad. Child Adolesc. Psych. 2000;39:1253–1259

PII: S0165-0327(04)00179-X

doi: 10.1016/j.jad.2004.05.004

Journal of Affective Disorders
Volume 84, Issue 2 , Pages 209-217 , February 2005