The validity of major depression with atypical features based on a community study

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Abstract

This article reports on evidence for the validity of major depression (MDD) with atypical features (defined as overeating and oversleeping) as a distinct subtype based on cross-sectional and 1-year prospective data from the Epidemiologic Catchment Area study. MDD with atypical features, when compared to MDD without atypical features, was associated with a younger age of onset, more psychomotor slowing, and more comorbid panic disorder, drug abuse or dependence, and somatization disorder. These differences could not be explained by differences in demographic characteristics or by symptom severity. This study, based on a community sample, found that major depression with atypical features may constitute a distinct subtype.

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      In contrast, chronic stress suppresses immune function, making the organisms more vulnerable for infection (Dhabhar et al., 2012). Atypical depression, on the other hand, is associated with lethargy, increased reactivity to environmental cues (i.e., depressed mood can lift during the depressive phase, although only temporarily), CRF deficiency, down-regulation of the HPA axis, and an altered immune function, making someone more vulnerable for inflammation (Horwath et al., 1992; Levitan et al., 1997; Lamers et al., 2010). The DSM-5 defines major depression with atypical features by i) mood reactivity (i.e., mood brightens in response to actual or potential positive events, i.e., paradoxical anhedonia) and ii) at least two of the following: significant weight gain or increase in appetite; hypersomnia (sleeping too much); heavy, leaden feelings in arms or legs; and long-standing pattern of interpersonal rejection sensitivity that results in significant social or occupational impairment.

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    Dr. J. Johnson died on January 10, 1992.

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