Advanced Search

The American Journal of Psychiatry, VOL. 158, No. 8

Letter to the Editor | August 01, 2001

Dr. Parker Replies

GORDON PARKER, M.D., PH.D, D.SC., F.R.A.N.Z.C.P.

Am J Psychiatry 2001;158:1334-1334. 10.1176/appi.ajp.158.8.1334

Article

References

text A A A

To the Editor: I agree strongly with Dr. Quitkin and colleagues that atypical depression can well be conceptualized according to our spectrum model of the nonmelancholic disorders. In seeking to articulate the model in the article, I restricted examples to the two most consistently identified disorders (i.e., "anxious depression" and "irritable/hostile depression") but suggested that other expressions must be presumed. In our current research, we included other personality styles (e.g., obsessional, introverted, impulsive) to examine the extent to which a meaningful definition of the nonmelancholic disorders involves respecting a temperament style diathesis. Atypical depression is a useful candidate as its (DSM-IV) criteria include "a long-standing pattern of extreme sensitivity to perceived interpersonal rejection," as well as a set of "atypical" depressive features.

The Columbia group’s initial observations and their validation efforts are another excellent example of the importance of building on clinical observation to identify intrinsic depressive types instead of using the homogenizing approach of modeling depression on a dimensional paradigm. In addition to undertaking further phenomenological and validation studies, the world might nevertheless appreciate their deriving a better name for this interesting syndrome.

Dr. Benazzi reports me somewhat incorrectly, as I actually stated that "those with bipolar disorder have been reported to be distinctly more likely to have melancholic and psychotic expressions of depression when in a depressed phase" (p. 1199) and referenced both Goodwin and Jamison (1) and one of our own studies (2) in support. The latter compared 83 bipolar and 904 unipolar patients on respective rates for (current) psychotic depression (N=16, 19.3%, versus N=90, 10.0%, respectively) and for DSM-III-R-defined melancholic depression (N=57, 68.7%, versus N=334, 36.9%). Thus, only 10 of our bipolar patients (12.0%), compared to 480 of our unipolar patients (53.1%), might have been presumed to have nonmelancholic depression.

I commented on Dr. Benazzi’s study group elsewhere (3). None of his subjects were receiving medication (which calls into question the illness severity of his group), the minimum duration criterion for hypomania in DSM-IV was not respected, and melancholic status was not formalized by use of DSM-IV or another criteria set. Instead, his prevalence data are in regard to unspecified melancholic "features"; the previously mentioned factors limit their interpretation.

Researchers (and clinicians) have long been concerned about the problematic diagnosis and differential diagnosis of bipolar II disorder. As bipolar I and II may or may not be independent conditions, there are advantages to conducting research studies with consideration of the disorders both in combination and separately.

Although patients with bipolar disorder appear highly likely to develop psychotic and melancholic expressions of depression, as with any generalization, there are exceptions. Thus, while I managed the treatment of a patient with bipolar disorder across many episodes of classic melancholic depression, she once appeared with a distinctly different clinical picture—a more reactive depressive disorder that appeared in response to her husband’s desertion. Although we concede that there may be exceptions, the possibility that bipolar depression is highly likely to be of the melancholic type allows an indirect approach to defining the nature of melancholia in more refined study groups.

References

Goodwin FK, Jamison KR: Manic-Depressive Illness. New York, Oxford University Press, 1990

Parker G, Roy K, Wilhelm K, Mitchell D, Hadzi-Pavlovic D: The nature of bipolar depression: implications for the definition of melancholia. J Affect Disord 2000; 59:217-224[PubMed][CrossRef]

Parker G: Response to Dr Benazzi. J Affect Disord (in press)

Goodwin FK, Jamison KR: Manic-Depressive Illness. New York, Oxford University Press, 1990

Parker G, Roy K, Wilhelm K, Mitchell D, Hadzi-Pavlovic D: The nature of bipolar depression: implications for the definition of melancholia. J Affect Disord 2000; 59:217-224[PubMed][CrossRef]

Parker G: Response to Dr Benazzi. J Affect Disord (in press)

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.

Submit a Comments

Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of JBJS editorial staff.

* = Required Field

Comment Author(s)*(if multiple authors, separate names by comma)

Example: John Doe

Affiliation & Institution*

Comment Title*

Comment*

Cancel

Print
E-mail

Recipient(s) will receive an email with a link (good for 72 hours) to 'Dr. Parker Replies' and do not need to have American Journal of Psychiatry account to access the content.
Your Name:*
Example: John Doe

Email Address:* CC Me:
Enter your valid email address. Example: jdoe@example.com

Recipient's Email Address:*
Separate multiple email address with semi-colons (up to 5).

Subject:* 's American Journal of Psychiatry: 'Dr. Parker Replies'
Subject for your email.

Message:
(Optional, message will truncate at 1000 characters)

Processing your request... Please Wait...

Copyright © in the material you requested is held by The American Psychiatric Association (unless otherwise noted). This email ability is provided as a courtesy, and by using it you agree that you are requesting the material solely for personal, non-commercial use, and that it is subject to The American Psychiatric Association's Terms of Use. The information provided in order to email this topic will not be used to send unsolicited email, nor will it be furnished to third parties. Please refer to The American Psychiatric Association's Privacy Policy for further information.

Copyright © American Psychiatric Association. All rights reserved.
Share
Get Citation

GORDON PARKER; Dr. Parker Replies. American Journal of Psychiatry. 2001 Aug;158(8):1334-1334.

Download citation file:

RIS (Zotero)

EndNote

BibTex

Medlars

ProCite

RefWorks

Reference Manager

Copyright © American Psychiatric Association. All rights reserved.
Reprints