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Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey

Published online by Cambridge University Press:  02 May 2019

Anamaria Brailean Open the ORCID record for Anamaria Brailean [Opens in a new window] ,
Jessica Curtis ,
Katrina Davis ,
Alexandru Dregan  and
Matthew Hotopf
Anamaria Brailean*
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Jessica Curtis
Affiliation:
Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
Katrina Davis
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom South London and Maudsley NHS Foundation Trust, London, United Kingdom
Alexandru Dregan
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Matthew Hotopf
Affiliation:
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom South London and Maudsley NHS Foundation Trust, London, United Kingdom
*
Author for correspondence: Anamaria Brailean, E-mail: [email protected]
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Abstract

Background

Depression is a heterogeneous disorder with multiple aetiological pathways and multiple therapeutic targets. This study aims to determine whether atypical depression (AD) characterized by reversed neurovegetative symptoms is associated with a more pernicious course and a different sociodemographic, lifestyle, and comorbidity profile than nonatypical depression (nonAD).

Methods

Among 157 366 adults who completed the UK Biobank Mental Health Questionnaire (MHQ), N = 37 434 (24%) met the DSM-5 criteria for probable lifetime major depressive disorder (MDD) based on the Composite International Diagnostic Interview Short Form. Participants reporting both hypersomnia and weight gain were classified as AD cases (N = 2305), and the others as nonAD cases (N = 35 129). Logistic regression analyses were conducted to examine differences between AD and nonAD in depression features, sociodemographic and lifestyle factors, lifetime adversities, psychiatric and physical comorbidities.

Results

Persons with AD experienced an earlier age of depression onset, longer, more severe and recurrent episodes, and higher help-seeking rates than nonAD persons. AD was associated with female gender, unhealthy behaviours (smoking, social isolation, low physical activity), more lifetime deprivation and adversity, higher rates of comorbid psychiatric disorders, obesity, cardiovascular disease (CVD), and metabolic syndrome. Sensitivity analyses comparing AD persons with those having typical neurovegetative symptoms (hyposomnia and weight loss) revealed similar results.

Conclusions

These findings highlight the clinical and public health significance of AD as a chronic form of depression, associated with high comorbidity and lifetime adversity. Our findings have implications for predicting depression course and comorbidities, guiding research on aetiological mechanisms, planning service use and informing therapeutic approaches.

Keywords

Adverse life eventsatypical depressioncardiovascular diseasedepression coursemetabolic syndromeobesitypsychiatric comorbiditiessocioeconomic disadvantageunhealthy lifestyle
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1129 - 1138
Copyright
Copyright © Cambridge University Press 2019

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References

Agosti, V and Stewart, JW (2001) Atypical and non-atypical subtypes of depression: comparison of social functioning, symptoms, course of illness, co-morbidity and demographic features. Journal of Affective Disorders 65, 75–79.CrossRefGoogle ScholarPubMed
Akiskal, HS and Benazzi, F (2005) Atypical depression: a variant of bipolar II or a bridge between unipolar and bipolar II? Journal of Affective Disorders 84, 209–217.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Arlington, VA: American Psychiatric Publishing.Google Scholar
Angst, J, Gamma, A, Sellaro, R, Zhang, H and Merikangas, K (2002) Toward validation of atypical depression in the community: results of the Zurich cohort study. Journal of Affective Disorders 72, 125–138.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, Silverstein, B, Ajdacic-Gross, V, Eich, D and Rossler, W (2006) Atypical depressive syndromes in varying definitions. European Archives of Psychiatry and Clinical Neuroscience 256, 44–54.CrossRefGoogle ScholarPubMed
Angst, J, Gamma, A, Benazzi, F, Ajdacic, V and Rossler, W (2007) Melancholia and atypical depression in the Zurich study: epidemiology, clinical characteristics, course, comorbidity and personality. Acta Psychiatrica Scandinavica 115, 72–84.CrossRefGoogle Scholar
Benazzi, F (2002 a) Can only reversed vegetative symptoms define atypical depression? European Archives of Psychiatry and Clinical Neuroscience 252, 288–293.CrossRefGoogle ScholarPubMed
Benazzi, F (2002 b) Should mood reactivity be included in the DSM-IV atypical features specifier? European Archives of Psychiatry and Clinical Neuroscience 252, 135–140.CrossRefGoogle ScholarPubMed
Blanco, C, Vesga-Lopez, O, Stewart, JW, Liu, SM, Grant, BF and Hasin, DS (2012) Epidemiology of major depression with atypical features: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry 73, 224–232.CrossRefGoogle Scholar
Case, SM, Sawhney, M and Stewart, JC (2018) Atypical depression and double depression predict new-onset cardiovascular disease in U.S. Adults. Depression and Anxiety 35, 10–17.CrossRefGoogle ScholarPubMed
Davidson, JR and Thase, ME (2007) A history of the concept of atypical depression. Journal of Clinical Psychiatry 68, 10–15.Google ScholarPubMed
Davis, KAS, Coleman, JRI, Adams, M, Allen, N, Breen, G, Cullen, B, Dickens, C, Fox, E, Graham, N, Holliday, J, Howard, LM, John, A, Lee, W, McCabe, R, McIntosh, A, Pearsall, R, Smith, DJ, Sudlow, C, Ward, J, Zammit, S and Hotopf, M (2018) Mental health in UK biobank: development, implementation and results from an online questionnaire completed by 157 366 participants. The British Journal of Psychiatry Open 4, 83–90.CrossRefGoogle ScholarPubMed
Fournier, JC, DeRubeis, RJ, Hollon, SD, Gallop, R, Shelton, RC and Amsterdam, JD (2013) Differential change in specific depressive symptoms during antidepressant medication or cognitive therapy. Behaviour Research and Therapy 51, 392–398.CrossRefGoogle ScholarPubMed
Fry, A, Littlejohns, TJ, Sudlow, C, Doherty, N, Adamska, L, Sprosen, T, Collins, R and Allen, NE (2017) Comparison of sociodemographic and health-related characteristics of UK biobank participants With those of the general population. American Journal of Epidemiology 186, 1026–1034.CrossRefGoogle ScholarPubMed
Glaus, J, Vandeleur, C, Gholam-Rezaee, M, Castelao, E, Perrin, M, Rothen, S, Bovet, P, Marques-Vidal, P, von Kanel, R, Merikangas, K, Mooser, V, Waterworth, DM, Waeber, G, Vollenweider, P and Preisig, M (2013) Atypical depression and alcohol misuse are related to the cardiovascular risk in the general population. Acta Psychiatrica Scandinavica 128, 282–293.Google ScholarPubMed
Harald, B and Gordon, P (2012) Meta-review of depressive subtyping models. Journal of Affective Disorders 139, 126–140.CrossRefGoogle ScholarPubMed
Horwath, E, Johnson, J, Weissman, MM and Hornig, CD (1992) The validity of major depression with atypical features based on a community study. Journal of Affective Disorders 26, 117–125.CrossRefGoogle ScholarPubMed
Jarrett, RB, Kraft, D, Schaffer, M, Witt-Browder, A, Risser, R, Atkins, DH and Doyle, J (2000) Reducing relapse in depressed outpatients with atypical features: a pilot study. Psychotherapy and Psychosomatics 69, 232–239.CrossRefGoogle ScholarPubMed
Kessler, RC and Ustun, TB (2004) The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle Scholar
Korte, SM, Prins, J, Krajnc, AM, Hendriksen, H, Oosting, RS, Westphal, KG, Korte-Bouws, GA and Olivier, B (2015) The many different faces of major depression: it is time for personalized medicine. European Journal of Pharmacology 753, 88–104.CrossRefGoogle ScholarPubMed
Koyuncu, A, Ertekin, E, Ertekin, BA, Binbay, Z, Yuksel, C, Deveci, E and Tukel, R (2015) Relationship between atypical depression and social anxiety disorder. Psychiatry Research 225, 79–84.CrossRefGoogle ScholarPubMed
Lamers, F, Vogelzangs, N, Merikangas, KR, de Jonge, P, Beekman, AT and Penninx, BW (2013) Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression. Molecular Psychiatry 18, 692–699.CrossRefGoogle ScholarPubMed
Lasserre, AM, Glaus, J, Vandeleur, CL, Marques-Vidal, P, Vaucher, J, Bastardot, F, Waeber, G, Vollenweider, P and Preisig, M (2014) Depression with atypical features and increase in obesity, body mass index, waist circumference, and fat mass: a prospective, population-based study. JAMA Psychiatry 71, 880–888.CrossRefGoogle ScholarPubMed
Lamers, F, Beekman, AT, van Hemert, AM, Schoevers, RA and Penninx, BW (2016 a) Six-year longitudinal course and outcomes of subtypes of depression. British Journal of Psychiatry 208, 62–68.CrossRefGoogle ScholarPubMed
Lamers, F, Cui, L, Hickie, IB, Roca, C, Machado-Vieira, R, Zarate, CA Jr. and Merikangas, KR (2016 b) Familial aggregation and heritability of the melancholic and atypical subtypes of depression. Journal of Affective Disorders 204, 241–246.CrossRefGoogle ScholarPubMed
Lee, S, Ng, KL and Tsang, A (2009) Prevalence and correlates of depression with atypical symptoms in Hong Kong. Australian and New Zealand Journal of Psychiatry 43, 1147–1154.CrossRefGoogle ScholarPubMed
Levinson, D, Potash, J, Mostafavi, S, Battle, A, Zhu, X and Weissman, M (2017) T26 - brief assessment Of Major depression For genetic studies: validation of Cidi-Sf screening With scid interviews. European Neuropsychopharmacology 27, S448.CrossRefGoogle Scholar
Levitan, RD, Lesage, A, Parikh, SV, Goering, P and Kennedy, SH (1997) Reversed neurovegetative symptoms of depression: a community study of Ontario. American Journal of Psychiatry 154, 934–940.Google ScholarPubMed
Lojko, D and Rybakowski, JK (2017) Atypical depression: current perspectives. Neuropsychiatric Disease and Treatment 13, 2447–2456.CrossRefGoogle ScholarPubMed
Matza, LS, Revicki, DA, Davidson, JR and Stewart, JW (2003) Depression with atypical features in the national comorbidity survey: classification, description, and consequences. Archives of General Psychiatry 60, 817–826.CrossRefGoogle ScholarPubMed
McGinn, LK, Asnis, GM, Suchday, S and Kaplan, M (2005) Increased personality disorders and Axis I comorbidity in atypical depression. Comprehensive Psychiatry 46, 428–432.CrossRefGoogle ScholarPubMed
Milaneschi, Y, Lamers, F, Peyrot, WJ, Abdellaoui, A, Willemsen, G, Hottenga, JJ, Jansen, R, Mbarek, H, Dehghan, A, Lu, C, Group CIW, Boomsma, DI and Penninx, BW (2016) Polygenic dissection of major depression clinical heterogeneity. Molecular Psychiatry 21, 516–522.CrossRefGoogle ScholarPubMed
Milaneschi, Y, Lamers, F, Bot, M, Drent, ML and Penninx, BWJH (2017 a) Leptin dysregulation Is specifically associated With Major depression With atypical features: evidence for a mechanism connecting obesity and depression. Biological Psychiatry 81, 807–814.CrossRefGoogle ScholarPubMed
Milaneschi, Y, Lamers, F, Peyrot, WJ, Baune, BT, Breen, G, Dehghan, A, Forstner, AJ, Grabe, HJ, Homuth, G, Kan, C, Lewis, C, Mullins, N, Nauck, M, Pistis, G, Preisig, M, Rivera, M, Rietschel, M, Streit, F, Strohmaier, J, Teumer, A, Van der Auwera, S, Wray, NR, Boomsma, DI and Penninx, B, Group CIW and the Major Depressive Disorder Working Group of the Psychiatric Genomics C (2017 b) Genetic association of Major depression With atypical features and obesity-related immunometabolic dysregulations. JAMA Psychiatry 74, 1214–1225.CrossRefGoogle ScholarPubMed
Nierenberg, AA, Alpert, JE, Pava, J, Rosenbaum, JF and Fava, M (1998) Course and treatment of atypical depression. Journal of Clinical Psychiatry 59, 5–9.Google ScholarPubMed
Niranjan, A, Corujo, A, Ziegelstein, RC and Nwulia, E (2012) Depression and heart disease in US adults. General Hospital Psychiatry 34, 254–261.CrossRefGoogle ScholarPubMed
Novick, JS, Stewart, JW, Wisniewski, SR, Cook, IA, Manev, R, Nierenberg, AA, Rosenbaum, JF, Shores-Wilson, K, Balasubramani, GK, Biggs, MM, Zisook, S and Rush, AJ & Investigators SD (2005) Clinical and demographic features of atypical depression in outpatients with major depressive disorder: preliminary findings from STAR*D. Journal of Clinical Psychiatry 66, 1002–1011.CrossRefGoogle ScholarPubMed
Parker, GB and Thase, ME (2007) Atypical depression: a valid subtype? Journal of Clinical Psychiatry 68, 18–22.Google ScholarPubMed
Patten, SB (1997) Performance of the composite international diagnostic interview short form for major depression in community and clinical samples. Chronic Diseases in Canada 18, 109–112.Google ScholarPubMed
Perugi, G, Akiskal, HS, Lattanzi, L, Cecconi, D, Mastrocinque, C, Patronelli, A, Vignoli, S and Bemi, E (1998) The high prevalence of “soft” bipolar (II) features in atypical depression. Comprehensive Psychiatry 39, 63–71.CrossRefGoogle ScholarPubMed
Posternak, MA and Zimmerman, M (2002) Partial validation of the atypical features subtype of major depressive disorder. Archives of General Psychiatry 59, 70–76.CrossRefGoogle ScholarPubMed
Rethorst, CD, Tu, J, Carmody, TJ, Greer, TL and Trivedi, MH (2016) Atypical depressive symptoms as a predictor of treatment response to exercise in Major depressive disorder. Journal of Affective Disorders 200, 156–158.CrossRefGoogle ScholarPubMed
Stewart, JW, McGrath, PJ, Rabkin, JG and Quitkin, FM (1993) Atypical depression. A valid clinical entity? Psychiatric Clinics of North America 16, 479–495.CrossRefGoogle ScholarPubMed
Sudlow, C, Gallacher, J, Allen, N, Beral, V, Burton, P, Danesh, J, Downey, P, Elliott, P, Green, J, Landray, M, Liu, B, Matthews, P, Ong, G, Pell, J, Silman, A, Young, A, Sprosen, T, Peakman, T and Collins, R (2015) UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLOS Medicine 12, e1001779.CrossRefGoogle ScholarPubMed
Sullivan, PF, Kessler, RC and Kendler, KS (1998) Latent class analysis of lifetime depressive symptoms in the national comorbidity survey. American Journal of Psychiatry 155, 1398–1406.CrossRefGoogle ScholarPubMed
Sunderland, M, Andrews, G, Slade, T and Peters, L (2011) Measuring the level of diagnostic concordance and discordance between modules of the CIDI-short form and the CIDI-Auto 2.1. Social Psychiatry and Psychiatric Epidemiology 46, 775–785.CrossRefGoogle ScholarPubMed
Thase, ME (2007) Recognition and diagnosis of atypical depression. Journal of Clinical Psychiatry 68, 11–16.Google ScholarPubMed
Ul-Haq, Z, Smith, DJ, Nicholl, BI, Cullen, B, Martin, D, Gill, JM, Evans, J, Roberts, B, Deary, IJ, Gallacher, J, Hotopf, M, Craddock, N, Mackay, DF and Pell, JP (2014) Gender differences in the association between adiposity and probable major depression: a cross-sectional study of 140 564 UK Biobank participants. BMC Psychiatry 14, 1–10.CrossRefGoogle ScholarPubMed
Withers, AC, Tarasoff, JM and Stewart, JW (2013) Is depression with atypical features associated with trauma history? Journal of Clinical Psychiatry 74, 500–506.CrossRefGoogle ScholarPubMed
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