Lots of doctors of our century and previous years have been bothering their heads about what major depressive disorderis and how to prevent it. In most materials a person with such an illness is described as sad, unhappy and very miserable. Many people go through it in one or another period of lifetime. Major depressive disorder (clinical depression) is a mental and mood disorder in which feelings of frustration, anger and sadness interfere everyday life for weeks or even longer.
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.
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.
Just as the relationships observed between light and mood and between stroke and depression have taught neuroscientists a great deal about mood disorders, study of the relationship between sleep and mood disorders has led to a better understanding of both the normal experience of sleep and the abnormal experiences of patients with mood disorders. The study of sleep has even indicated promising treatment approaches.
The mood disorders, especially major depression, have many symptoms besides change in mood. I’ve discussed many of these in the chapters on depression and bipolar disorder. Changes in appetite and sleep, energy, activity level, and concentration are some of these symptoms, and in some people they may dominate the clinical picture or at least be so prominent that other types of illnesses can be mistakenly diagnosed.