Untreated major depressive disorder with and without atypical features: A clinical comparative study

Aims and methodA comparative study of major depression with and without atypical features (as per DSM IV TR criteria) was planned to assess illness characteristics, resulting dysfunction and co-morbidities, which can have important implications in its management. Serially, 107 newly registered patients with depression not taking any treatment for at least a month were included. Patients with psychotic features in present or past, known bipolar disorder and likely organic aetiology were excluded. They were interviewed using SCID I (Structured clinical interview for DSM IV axis I disorders). Impulsiveness, suicidal ideation and functioning in various spheres was also assessed and compared between those with and without atypical features.ResultsAtypical features were seen in a significant number (55.14%) of patients especially from urban and semi-urban areas. Interpersonal sensitivity and leaden paralysis were the commonest atypical features apart from mood reactivity. Presence of hypersomnia and/or hyperphagia documented in 36 (33.65%) of 107 patients. Comparison of patients with and without atypical features revealed no significant difference in illness characteristics including suicidal ideation. However, they differed in level of impulsiveness and associated psychiatric co-morbidities. Also, deterioration of functioning with rising HDRS was more significant in patients without atypical features.Clinical implicationsPresence of atypical features is common in patients with major depressive disorder. These patients should be vigilantly assessed and managed in view of equal morbidity but different co-morbidities like anxiety and soft bipolar disorders than those without atypical features.

► Cross sectional study of 107 patients with major depressive episode/disorder not on any treatment currently.
► When asked for the presence of atypical features as per DSM IV TR definition, 55.14% had atypical features.
► Presence of hypersomnia and/or hyperphagia documented in 33.65% of patients.
► Comparison revealed no significant difference in illness characteristics including suicidal ideation.
► Co-morbid diagnoses were different. Functioning worse with rising HDRS in patients without atypical features.