title: [Atypical depression: Clinical perspectives].
abstract: OBJECTIVE
  This paper examines whether atypical depression is still a valid entity as a diagnosis subtype in the light of publications with most recent antidepressants.
  
  
  METHODS
  First, we present the origins of the diagnosis sub-specification of atypical depression, which is based on a different drug response to tricyclic antidepressants and mono amino oxydase inhibitors. Secondly, we discuss the different definitions that can be found for the terms of atypical depression. We present more specifically the definition of atypical depression as it is described in the DSM-IV, with its most important criterion: mood reactivity. Then we present a review of scientific publications questioning atypical depression validity as a clinical syndrome (based on medline researches). We will see whether this diagnosis is still relevant with the latest drugs used to treat mood disorders. A special focus is made on the link between atypical depression and bipolar disorder, based on Benazzi's work.
  
  
  RESULTS
  Most of publications confirm that atypical depression is a valid syndrome regarding first antidepressants clinical trials. Nevertheless, more studies with the latest antidepressants and atypical antipsychotics are needed to confirm this hypothesis. The link between atypical depression and bipolar disorders seems to be quite strong although it requires further investigations.
  
  
  CONCLUSIONS
  There are very few double-blind drug trials focusing on atypical depressions and results need to be confirmed by trials with new drugs. Moreover, we regret that there are no studies including cerebral imagery. More studies are also needed on neurobiology and psychotherapy specificity.
  
  
  CONCLUSIONS
  Atypical depression is still a useful concept, because of its specific clinical presentation, evolution and treatments, even if more studies should be done. Atypical depression could also be useful to diagnose more easily some bipolar disorders and should help clinicians to focus more on suicidal risks and addiction evaluation for these patients, considering the mood reactivity and the link with bipolar disorder. To conclude, we propose that atypical depression should still figure in the future DSM-V for these different reasons.
authors.affiliation: Centre hospitalier d'Erstein, 13, route de Krafft, BP 30063, 67152 Erstein, France. Electronic address: m.lutz@ch-erstein.fr.
authors.forename: M
authors.initials: M
authors.lastname: Lutz
authors.forename: A
authors.initials: A
authors.lastname: Morali
authors.forename: J-P
authors.initials: JP
authors.lastname: Lang
mesh_terms: D000339:Affect / Q000187:drug effects*; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects* / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D013577:Syndrome; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Atypical depression; Bipolar disorder; DSM-IV; DSM-V; Dépression atypique; Troubles bipolaires