title: Efficacy and safety of selegiline transdermal system (STS) for the atypical subtype of major depressive disorder: pooled analysis of 5 short-term, placebo-controlled trials.
abstract: OBJECTIVE
  The objective of the present study is to investigate the efficacy and safety of the selegiline transdermal system (STS) in major depressive disorder (MDD) with atypical features.
  
  
  METHODS
  This was a post-hoc analysis of 5 short-term trials. The atypical subtype was defined as the presence of at least 1 item with a score of 2 or greater from items 22-26 on the 28-item Hamilton Depression Rating Scale (HAMD-28), and a maximum score of 1 point for items 6 (insomnia late), 12 (somatic symptoms, gastrointestinal), and 16 (loss of weight) to exclude vegetative features of melancholic depression. The mean changes of HAMD-28 total score from baseline to the endpoint (response rate defined as ≥50% reduction in HAMD-28 scores and remission rate defined as ≤10 HAMD-28 total score at the treatment endpoint) were compared between atypical and nonatypical groups.
  
  
  RESULTS
  In this analysis, 352 subjects (STS = 168 vs placebo = 184) met the definition of atypical subtype at baseline. STS (n = 641) significantly decreased HAMD-28 total score compared with placebo (n = 648) from beginning to end of treatment (-10.7 ± 9.3 vs -9.4 ± 9.3; p = 0.014). STS showed comparable efficacy in patients with the atypical subtype compared with the nonatypical subtype for placebo-subtracted mean change in HAMD-28 total score (-2.11 ± 1.01 vs. -1.0 ± 0.60; p = 0.34), odds ratio (OR) for response (1.41 vs 1.23, p = 0.62), and OR for remission (1.77 vs 1.18, p = 0.22).
  
  
  CONCLUSIONS
  STS appears to be comparably efficacious and tolerable in atypical and nonatypical subtypes of MDD. Adequately powered, controlled, clinical trials are necessary to confirm our findings.
authors.affiliation: 1Department of Psychiatry,Duke University Medical Center,Durham,North Carolina,USA.
authors.forename: Chi-Un
authors.initials: CU
authors.lastname: Pae
authors.affiliation: 1Department of Psychiatry,Duke University Medical Center,Durham,North Carolina,USA.
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
authors.affiliation: 1Department of Psychiatry,Duke University Medical Center,Durham,North Carolina,USA.
authors.forename: Saeheon
authors.initials: S
authors.lastname: Jang
authors.affiliation: 3Mylan Specialty L.P.,Basking Ridge,New Jersey,USA.
authors.forename: Kimberly B
authors.initials: KB
authors.lastname: Portland
authors.affiliation: 1Department of Psychiatry,Duke University Medical Center,Durham,North Carolina,USA.
authors.forename: Sungwon
authors.initials: S
authors.lastname: Jung
authors.affiliation: 4Department of Psychiatry,University of California-San Francisco,San Francisco,California,USA.
authors.forename: J Craig
authors.initials: JC
authors.lastname: Nelson
mesh_terms: D000279:Administration, Cutaneous; D000328:Adult; D003865:Major Depressive Disorder / Q000145:classification / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use*; D011602:Psychophysiologic Disorders / Q000523:psychology; D016032:Randomized Controlled Trials as Topic; D012642:Selegiline / Q000627:therapeutic use*; D007319:Sleep Initiation and Maintenance Disorders / Q000523:psychology; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D008996:Monoamine Oxidase Inhibitors; D012642:Selegiline