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Atypical depression is a confusing concept to many of us in primary care. Yet, as this supplement describes, it is common and is one area in which a new treatment option–the selegiline patch–might be of great benefit. Understanding the history of the concept (as described by Jonathan R. T. Davidson, M.D.), from first description in the early 1960s to the present, and its changing definition over this interval helps in understanding the diagnostic and treatment literature. The DSM-IV-TR criteria are not well supported by research and are likely to be revised with the next edition of the DSM (as described by Gordon B. Parker, M.D., Ph.D.). The central characteristics include the interplay of sensitivity to rejection, predisposition to anxiety as a response (including panic and social anxiety disorders), and possibly a variety of dysfunctional responses, such as hypersomnia and hyperphagia. Whether the current primary characteristic of mood reactivity (improved mood in response to favorable events) is truly central to the definition is open to question. However defined, atypical depression is common, constituting a third of inpatient cases and half or more of outpatient cases of depression, including many of those we see in primary care. Many of these cases are individuals who have responded poorly to past treatments and might receive benefit from the new selegiline patch. Mark H. Rapaport, M.D., provides a clear overview of the patch and how it brings back an old and particularly effective treatment modality, the monoamine oxidase inhibitor, but in a modality safe for routine primary care use without dietary restrictions at its base dose. For primary care, this supplement can expand diagnostic and treatment options for a large group of our depressed patients, a group we often have great difficulty in helping.
Larry Culpepper, MD, MPH
Editor in Chief
The Primary Care Companion to the Journal of Clinical Psychiatry