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The Identification and Validation of Distinct Depressive Syndromes in a Population-Based Sample of Female Twins

The Identification and Validation of Distinct Depressive Syndromes in a Population-Based Sample... Abstract Since Aubrey Lewis' classic study there has been debate about whether the distinction between depressive subtypes is categorical or dimensional.1-6 A recent article by Kendler et al7 supports a categorical classification of depressive subtypes. Using a different means of validating nosological distinctions, our group reached similar conclusions and we think it relevant to review the similarities and differences between our findings and those of Kendler et al. In a prospective epidemiological study of adult female twins, Kendler et al used latent class analysis and identified 3 depressive subtypes—mild typical, atypical, and severe typical depression. Subjects with atypical depression were characterized by reversed vegetative depressive symptoms (overeating and oversleeping). These groups differed on many validating criteria, supporting a categorical distinction. We reached a similar conclusion using psychopharmacologic dissection, a distinctly different method.8 In a series of 6 studies, patients with nonautonomous mood were randomized to receive imipramine, phenelzine, References 1. Lewis AJ. A Clinical and Historical Survey of Depressive States: Based on the Study of 61 Cases. Adelaide, Australia: University of Adelaide; 1931. Thesis. 2. Lewis AJ. Melancholia: prognostic studies and case material . J Ment Sci . 1936;82:488-558. 3. Kiloh LG, Andrews G, Neilson M, Bianchi GN. The relationship of the syndromes called endogenous and neurotic depression . Br J Psychiatry . 1972;121:183-196.Crossref 4. Kiloh LG, Garside RF. Depression: a multivariate study of Sir Aubrey Lewis's data on melancholia . Aust N Z J Psychiatry . 1977;11:149-156.Crossref 5. Kendell RE. Clinical validity . In: Robins LN, Barrett JE, eds. The Validity of Psychiatric Diagnosis . New York, NY: Raven Press; 1989:305-323. 6. Parker G, Hadzi-Pavlovic D. Old data, new interpretation: a re-analysis of Sir Aubrey Lewis' MD thesis. Psychological Med. 1993;23:859-870. 7. Kendler KS, Eaves LJ, Walters EE, Neale MC, Heath AC, Kessler RC. The identification and validation of distinct depressive syndromes in a population-based sample of female twins . Arch Gen Psychiatry . 1996;53:391-399.Crossref 8. Klein DF. The pharmacological validation of diagnoses . In: Robins LN, Barrett JE, eds. The Validity of Psychiatric Diagnoses . New York, NY: Raven Press; 1989:203-217. 9. Quitkin FM, Stewart JS, McGrath PJ, Liebowitz MR, Harrison WM, Tricamo E, Klein DF, Markowitz JS, Rabkin JG, Wager SG. Phenelzine versus imipramine in the treatment of probable atypical depression: defining syndrome boundaries of selective MAOI responders . Am J Psychiatry . 1988;145:306-311. 10. Quitkin FM, McGrath PJ, Stewart JW, Harrison W, Wager SG, Nunes E, Rabkin JG, Tricamo E, Markowitz J, Klein DF. Phenelzine and imipramine in mood reactive depressives: further delineation of the syndrome of atypical depression . Arch Gen Psychiatry . 1989;46:787-793.Crossref 11. Quitkin FM, McGrath PJ, Stewart JW, Harrison W, Tricamo E, Wager SG, Ocepek-Welikson K, Nunes E, Rabkin JG, Klein DF. Atypical depression, panic attacks, and response to imipramine and phenelzine: a replication . Arch Gen Psychiatry . 1990;47:935-941.Crossref 12. Quitkin FM, Harrison W, Stewart JW, McGrath PJ, Tricamo E, Ocepek-Welikson K, Rabkin JG, Wager SG, Nunes E, Klein DF. Response to phenelzine and imipramine in placebo nonresponders with atypical depression: a new application of the crossover design . Arch Gen Psychiatry . 1991;48:319-323.Crossref 13. Quitkin FM, Stewart JW, McGrath PJ, Tricamo E, Rabkin JG, Ocepek-Welikson K, Nunes EV, Harrison W, Klein DF. Columbia atypical depression: a subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo . Br J Psychiatry . 1993;163( (suppl 21) ):30-34. 14. Stewart JW, McGrath PJ, Rabkin JG, Quitkin FM. Atypical depression: a valid clinical entity? Psychiatr Clin North Am . 1993;16:479-495. 15. Glassman A, Kantor S, Shostak M. Depressions, delusions and drug response . Am J Psychiatry . 1975;132:716-719. 16. Joyce PR, Paykel ES. Predictors of drug response in depression . Arch Gen Psychiatry . 1989;46:89-99.Crossref 17. Rothschild R, Quitkin HM, Quitkin FM, Stewart JW, Ocepek-Welikson K, McGrath PJ, Tricamo E. A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives . Int J Eating Disord . 1994;15:1-9.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

The Identification and Validation of Distinct Depressive Syndromes in a Population-Based Sample of Female Twins

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Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1997.01830220100016
Publisher site
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Abstract

Abstract Since Aubrey Lewis' classic study there has been debate about whether the distinction between depressive subtypes is categorical or dimensional.1-6 A recent article by Kendler et al7 supports a categorical classification of depressive subtypes. Using a different means of validating nosological distinctions, our group reached similar conclusions and we think it relevant to review the similarities and differences between our findings and those of Kendler et al. In a prospective epidemiological study of adult female twins, Kendler et al used latent class analysis and identified 3 depressive subtypes—mild typical, atypical, and severe typical depression. Subjects with atypical depression were characterized by reversed vegetative depressive symptoms (overeating and oversleeping). These groups differed on many validating criteria, supporting a categorical distinction. We reached a similar conclusion using psychopharmacologic dissection, a distinctly different method.8 In a series of 6 studies, patients with nonautonomous mood were randomized to receive imipramine, phenelzine, References 1. Lewis AJ. A Clinical and Historical Survey of Depressive States: Based on the Study of 61 Cases. Adelaide, Australia: University of Adelaide; 1931. Thesis. 2. Lewis AJ. Melancholia: prognostic studies and case material . J Ment Sci . 1936;82:488-558. 3. Kiloh LG, Andrews G, Neilson M, Bianchi GN. The relationship of the syndromes called endogenous and neurotic depression . Br J Psychiatry . 1972;121:183-196.Crossref 4. Kiloh LG, Garside RF. Depression: a multivariate study of Sir Aubrey Lewis's data on melancholia . Aust N Z J Psychiatry . 1977;11:149-156.Crossref 5. Kendell RE. Clinical validity . In: Robins LN, Barrett JE, eds. The Validity of Psychiatric Diagnosis . New York, NY: Raven Press; 1989:305-323. 6. Parker G, Hadzi-Pavlovic D. Old data, new interpretation: a re-analysis of Sir Aubrey Lewis' MD thesis. Psychological Med. 1993;23:859-870. 7. Kendler KS, Eaves LJ, Walters EE, Neale MC, Heath AC, Kessler RC. The identification and validation of distinct depressive syndromes in a population-based sample of female twins . Arch Gen Psychiatry . 1996;53:391-399.Crossref 8. Klein DF. The pharmacological validation of diagnoses . In: Robins LN, Barrett JE, eds. The Validity of Psychiatric Diagnoses . New York, NY: Raven Press; 1989:203-217. 9. Quitkin FM, Stewart JS, McGrath PJ, Liebowitz MR, Harrison WM, Tricamo E, Klein DF, Markowitz JS, Rabkin JG, Wager SG. Phenelzine versus imipramine in the treatment of probable atypical depression: defining syndrome boundaries of selective MAOI responders . Am J Psychiatry . 1988;145:306-311. 10. Quitkin FM, McGrath PJ, Stewart JW, Harrison W, Wager SG, Nunes E, Rabkin JG, Tricamo E, Markowitz J, Klein DF. Phenelzine and imipramine in mood reactive depressives: further delineation of the syndrome of atypical depression . Arch Gen Psychiatry . 1989;46:787-793.Crossref 11. Quitkin FM, McGrath PJ, Stewart JW, Harrison W, Tricamo E, Wager SG, Ocepek-Welikson K, Nunes E, Rabkin JG, Klein DF. Atypical depression, panic attacks, and response to imipramine and phenelzine: a replication . Arch Gen Psychiatry . 1990;47:935-941.Crossref 12. Quitkin FM, Harrison W, Stewart JW, McGrath PJ, Tricamo E, Ocepek-Welikson K, Rabkin JG, Wager SG, Nunes E, Klein DF. Response to phenelzine and imipramine in placebo nonresponders with atypical depression: a new application of the crossover design . Arch Gen Psychiatry . 1991;48:319-323.Crossref 13. Quitkin FM, Stewart JW, McGrath PJ, Tricamo E, Rabkin JG, Ocepek-Welikson K, Nunes EV, Harrison W, Klein DF. Columbia atypical depression: a subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo . Br J Psychiatry . 1993;163( (suppl 21) ):30-34. 14. Stewart JW, McGrath PJ, Rabkin JG, Quitkin FM. Atypical depression: a valid clinical entity? Psychiatr Clin North Am . 1993;16:479-495. 15. Glassman A, Kantor S, Shostak M. Depressions, delusions and drug response . Am J Psychiatry . 1975;132:716-719. 16. Joyce PR, Paykel ES. Predictors of drug response in depression . Arch Gen Psychiatry . 1989;46:89-99.Crossref 17. Rothschild R, Quitkin HM, Quitkin FM, Stewart JW, Ocepek-Welikson K, McGrath PJ, Tricamo E. A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives . Int J Eating Disord . 1994;15:1-9.Crossref

Journal

Archives of General Psychiatry – American Medical Association

Published: Oct 1, 1997

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