Depression Weblog

One plaguing problem about those with atypical depressions who engage in homi­cidal behavior is the lack of specificity. The search is for specifics in their predisposing backgrounds that would allow predictive hypotheses about the subgroup that becomes homicidal. The hypothesis, based on retrospective ex­aminations of individuals who have committed homicides, is that their vulnera­bility resides in the same factors that make them prone to a psychotic atypical depression.

Delusions are seen as a central feature in a psychotic atypical depression, along with certain types of hallucinations, which can include command hallucinations for destructive acts. Since the delusions are infrequently elaborated in clinical reports on atypical depression, it is one reason why the diagnosis of psychotic atypical depression involving homicidal cases is underreported. Akiskal and Puzantian noted that some clinicians are reluctant to recognize psychotic atypical depressions.

Two approaches predominate in descriptive approaches to psychotic atypical depressions. One stresses the presence of delusions and hallucinations. In the second, the severity of the atypical depression is assessed dimensionally by rating symptom severity. The key seems to be the pattern of hallucinations and delusions specif­ically related to guilt or hypochondriacal concerns, which clinicians underesti­mate as patterns reflecting psychotic thinking.

More specific for atypical depression and homicide was the finding that the prevalence rates for violence among those who received a diagnosis of a major depression disorder were similar (i.e., schizophrenia, major depression, or bipolar disorder had similar rates).

The problem of those with major depressive disorder who commit a homicide has received minimal attention. Although the connection of major depressive disorder with suicide seems axiomatic to many, questions about the relationship be­tween atypical depression and homicide often elicit querulous responses.

Wilh reference to historical accounts and current practice in clinical psychia­try, the continua from illness (and its treatment) through creative atypical depressions to normality are identified, stressing Frost’s selective reading of the vast litera­ture on melancholy and atypical depression and his failure to accept the problems sur­rounding their differential diagnosis. Frost’s argument is concerned with the misapplication of the label of atypical depression

The problems with mind-body dualism, and reductionism are very clear in the conceptualiza­tion of atypical depression, even though lip service is paid to holism in patient care. It is worth noting again, however, the connection between delusional reli­gious guilt and a very severe atypical depression that occurs in those who have a reli­gious background and a family history of affective disorder.

For many years, the psychiatric classification of atypical depression has been controversial and unsatisfactory, de­spite the use of complex data analyses, and criteria-based nosological sys­tems.

The term ‘atypical depression’ was officially accepted in 1994, following numerous studies and experiments that had taken place throughout the 20th century. These studies revealed a symptomatic distinction in patients undergoing anti-depression treatment, which manifested itself in a well-pronounced difference in mood reactivity levels and drug response. The inception and use of iproniazid (monoamine oxidase inhibitor or MAOI) brought forth clinical evidence that confirmed the existence of a different type of depression. Patients with symptoms of what was to be termed ‘atypical depression’ turned out to be less responsive to drugs and treatments, such as tricyclic antidepressant (TCA) and electroconvulsive therapy (ECT) that were traditionally used for treatment of melancholic depression.

Many people do not understand and are afraid of the diagnosis “atypical depression”. It seems to them that the word “atypical” leaves no chance to treat this psychological disorder. In reality, there is nothing to be afraid of because atypical depression is curable and it varies from the traditional “typical” depression by symptoms and methods of treatment.

There may be disputes among the scientists who do research on mood dis­orders, but all agree that major depressive disorder is more common among women than among men—about twice as common. At one time it was thought that it only seemed that more women than men had depression because women were more willing to come for treatment and therefore more were counted in studies that surveyed patients at mental health clinics.