title: Atypical depressive syndromes in varying definitions.
abstract: BACKGROUND
  Atypical depression (AD) exhibits distinct patterns of gender,bipolar-II disorder, genetic, and neuro-biological measures. Using prospective data from a community sample, this paper identifies criteria (and correlates) for an AD syndrome that maximizes the association with female sex and bipolar-II.
  
  
  METHODS
  The Zurich cohort study is composed of 591 subjects selected from a population-based cohort of young adults in the canton of Zurich in Switzerland, screened in 1978 and followed with six interviews through 1999. Seven definitions of atypical depression were tested, using varying combinations of vegetative symptoms and mood reactivity.
  
  
  RESULTS
  The atypical definitions using 2 of 3 (fatigue, overeating, oversleeping) or 2 of 2 (overeating, oversleeping) vegetative symptoms showed the strongest association with gender, bipolarity, and family history of mania. The 2/3 definition was chosen for further analysis due to its high sensitivity for identifying these characteristics. This syndrome had cumulated weighted prevalence of 16.4% (males 9.7%, females 23%); when associated with major depressive episodes, 8.2% (males 3.2%, females 15.1%). AD patients were characterized by high treatment rates, severity, and work impairment, early age of onset and long illness. AD was comorbid with social phobia, binge eating, neurasthenia, migraine headache, and subjective cognitive impairment.
authors.affiliation: Zurich University Psychiatric Hospital, Lenggstrasse 31, PO Box 1931, 8032 Zurich, Switzerland. jangst@bli.unizh.ch
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.forename: Alex
authors.initials: A
authors.lastname: Gamma
authors.forename: Franco
authors.initials: F
authors.lastname: Benazzi
authors.forename: Brett
authors.initials: B
authors.lastname: Silverstein
authors.forename: Vladeta
authors.initials: V
authors.lastname: Ajdacic-Gross
authors.forename: Dominique
authors.initials: D
authors.lastname: Eich
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000235:genetics / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D010641:Phenotype; D011446:Prospective Studies; D012737:Sex Factors; D013223:Statistics as Topic; D013557:Switzerland