Which of the following is not a feature of atypical depression?
(a) TCAs are better than MAO and SSRI for treatmentRef: Complete review of psychiatry by Dr. Prashant Agrawal, ed., 2018, ch - 3, pg. 60Atypical depression as a biologically distinct subtype of depression has been suggested by its superior response to MAOIs compared to TCAs and from cerebral laterality, as well from genetic and neuroendocrine studies. (CTP 10th Eds, ICD10,DSM-V)Criteria for atypical depression* According to the DSM-V, symptoms of depression with atypical features include the following:A. Mood reactivity (i.e., mood brightens in response to positive events)B. Two or more of the following features, present for most of the time, for at least two weeks:1. Increased appetite2. Increased sleep3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)4. Interpersonal rejection sensitivity (not limited to episodes of mood disturbance) resulting in significant social or occupational impairmentC. Criteria are not met for melancholic(ENDOGENOUS/BIOLOGICAL) or catatonic features of depression.So Atypical depression can be defined as a subgroup of Depression (DSM5,ICD-10) the main criterion of atypical depression is the presence of mood reactivity in combination with at least two of four secondary criteria (hypersomnia, increased appetite or weight gain, leaden paralysis, and interpersonal rejection sensitivity).Note: The chief complaint of fatigue as part of the symptom of leaden paralysis in people with atypical depression can also result in misdiagnosis of chronic fatigue syndrome. That is why patients with no physical signs and symptoms (like tender lymph nodes, sore throat) but with history of long-standing fatigue should be carefully screened for presence of atypical depression.Other importent feature of ATYPICAL DEPRESSION are (compared to the patients with non-atypical depression)1. Female gender2. Earlier age of onset3. Longer disease duration4. More depressive recurrences5. More chronic disease course6. More suicidality7. More severe symptoms8. More comorbid diagnoses - dysthymia, substance abuse, antisocial personality disorder, panic disorder and social phobia9. Verbal fluency and psychomotor speed tasks seem to to differentiate atypical subtype of depression from melancholic subtype, since melancholic patients performed worst.10. Is often associated with HPA axis down-regulation, inflammatory and metabolic dysregulation11. Usually have higher rates of a history of neglect and abuse during the childhood and familial alcohol and drug disorders.Major differentiating symptoms of atypical and melancholic (part of non-atypical) depressionSymptomAtypicalMelancholic (nonatypical)Mood reactivityMood reactivity present (brightens in response to positive events)Lack of mood reactivity even temporarily, when something good happensWeight appetiteSignificant weight gain or increase in appetiteSignificant anorexia or weight lossSleepExcessive sleep all through the dayDecreased sleep with early morning awakeningPsychomotor activityLeaden paralysis (heavy feeling in arms, legs)Psychomotor retardation or agitationPersonality thinkingInterpersonal rejection sensitivity not limited to mood episodesExcessive or inappropriate guild during mood episodesDiurnal variationDepression likely worse in evening (not part of diagnostic criteria)Depression regularly worse in morningTreatment* Psychotherapeutic treatments are often found to be less effective than pharmacotherapy.* Such patients responded better to monoamine oxidase inhibitors (M AOIs) compared to tricyclic antidepressants (TCAs).
TCAs are better than MAO and SSRI for treatment
Variable Mood responding to positive stimulus in surroundings
Increased sleep and weight gain
Marked fatigue and heaviness in the body
Mood Disorders