The treatment of atypical depression

Summary Atypical depression differs from typical (endogenomorphic) depression not only in terms of the primary determinant, mood reactivity, but also by the presence of at least one of four atypical symptoms, hyperphagia, hypersomnia, rejection sensitivity and leaden paralysis. In addition to the differential therapeutic response reported by various authors, these two types of depression can be differentiated by various biological measures including the dexamethasone suppression test, tyramine excretion following loading, REM latency, etc. A series of studies comparing phenelzine with imipramine and placebo in subgroups of atypical depressives showed better results with the tricyclic than with placebo; however phenelzine consistently gave the best results in this type of depression. The hypothesis is advanced that the difference between typical and atypical classes of depression could be accounted for by the loss of the ability to experience both “anticipatory” or “consummatory” pleasure in typical depression, but only anticipatory pleasure in atypical depression.