Stewart Jonathan W, McGrath Patrick J, Quitkin Frederic M
New York State Psychiatric Institute, New York, NY 10032, USA.
Neuropsychopharmacology. 2002 Feb;26(2):237-45. doi: 10.1016/S0893-133X(01)00313-X.
DSM IV defines its atypical features depression modifier mainly by current symptoms. Relative to depressed patients with melancholic features, those with atypical features often present with earlier onset of a more chronic disorder and are less likely to benefit from tricyclic antidepressant (TCA). We, therefore, hypothesized that within depressed patients with atypical features those with illness course most similar to that of melancholia would be most TCA-responsive, those whose illness course least resembled that of melancholia would be least TCA responsive. Two patient groups were treated with TCA, monoamine oxidase inhibitor, or placebo with nonresponders crossed to alternative treatment. One group met DSM IV criteria for atypical features and the other nearly met these criteria. Early onset, chronically depressed patients with DSM IV atypical features had poor TCA response relative to others. Patients with "probable" atypical features (mood reactivity plus one associated atypical feature) and nonresponders crossed to alternate treatment confirmed this. Findings suggest that application of DSM IV atypical features might best be limited to those with early onset of chronic dysphoria.
《精神疾病诊断与统计手册》第四版（DSM-IV）主要根据当前症状来定义其非典型特征性抑郁症修饰词。相对于具有抑郁特征的抑郁症患者，具有非典型特征的患者往往更早发病，病情更具慢性化，且从三环类抗抑郁药（TCA）治疗中获益的可能性更小。因此，我们推测，在具有非典型特征的抑郁症患者中，病程与抑郁性抑郁症最相似的患者对TCA反应最佳，而病程与抑郁性抑郁症最不相似的患者对TCA反应最差。两组患者分别接受TCA、单胺氧化酶抑制剂或安慰剂治疗，无反应者交叉接受替代治疗。一组符合DSM-IV非典型特征标准，另一组接近这些标准。与其他患者相比，具有DSM-IV非典型特征的早发性、慢性抑郁症患者对TCA反应较差。具有“可能的”非典型特征（情绪反应性加一项相关非典型特征）的患者以及交叉接受替代治疗的无反应者证实了这一点。研究结果表明，DSM-IV非典型特征的应用可能最好仅限于那些早发性慢性烦躁不安的患者。
