Subtypes of depression and their overlap in a naturalistic inpatient sample of major depressive disorder

Abstract

Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.

Combining machine learning algorithms for prediction of antidepressant treatment response

“…Similar to our results, the core emotional cluster consisted of symptoms related to mood, energy, concentration, interest, and self‐worth. Interestingly, both emotional clusters resemble the traditional melancholic subtype of depression, indicating that data‐driven subtypes can agree with clinical experience 42 . However, the “core emotional” cluster suggested by Chekroud also included suicidality, which sometimes is interpreted as atypical symptom and did not differ between atypical and other types of depression in other analyses 43 .…”

Chronic Stress Induces Activity, Synaptic, and Transcriptional Remodeling of the Lateral Habenula Associated with Deficits in Motivated Behaviors

“…The clinical manifestations of depression are highly variable, and patients with different symptoms are often grouped into the same diagnostic category even if they have distinct underlying pathophysiologies (Akil et al, 2018;Drysdale et al, 2017;Waters and Mayberg, 2017). Recent years have witnessed a growing awareness of this problem, and several attempts have been made to identify valid and meaningful subtypes based on symptoms, onset, course or severity (ten Have et al, 2016;van Loo et al, 2012;Musil et al, 2018). Importantly, a recent study suggested that patients with depression can be subdivided into four symptomatic subtypes based on distinct patterns of dysfunctional connectivity in limbic and frontostriatal circuits (Drysdale et al, 2017).…”

“…anhedonia, social withdrawal), which are thought to reflect some of the core symptoms seen in depressed humans (Berton et al, 2012;Monteggia et al, 2018;Nestler and Hyman, 2010;Willner et al, 1992). Although patients with depression show a highly diverse set of combination of symptoms (Carragher et al, 2009;ten Have et al, 2016;Musil et al, 2018;Willner et al, 2013), scientists often considered CS-exposed animals as a homogeneous population in their search for a pathological mechanism (Agudelo et al, 2014;Cui et al, 2018;Frisbee et al, 2015;Li et al, 2013;Moreines et al, 2017;Ramirez et al, 2015;Schweizer et al, 2009;Seo et al, 2018;. However, simply dividing animals into "stressed" and "non-stressed" groups may not account for the diversity of behavioral phenotypes that arise in response to CS exposure.…”

Identification of 14-3-3 epsilon as a regulator of the neural apoptotic pathway for chronic-stress-induced depression

“…Depression is a complex mood disorder with high individual heterogeneity. Despite distinct pathophysiologies underlying the clinical manifestations of depression, MD patients with symptomatic differences are often categorized into the same diagnostic group ( Beijers et al., 2019 ; Musil et al, 2018 ). Like humans, rodents display great heterogeneity in their response to stress and adversity.…”