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Atypical Depression

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1. Atypical depression and non-atypical depression: Is HPA axis function a biomarker? A systematic review. (PubMed)

Atypical depression and non-atypical depression: Is HPA axis function a biomarker? A systematic review. The link between the abnormalities of the Hypothalamic-pituitary-adrenal (HPA) axis and depression has been one of the most consistently reported findings in psychiatry. At the same time, multiple studies have demonstrated a stronger association between the increased activation of HPA-axis and melancholic, or endogenous depression subtype. This association has not been confirmed (...) for the atypical subtype, and some researchers have suggested that as an antinomic depressive subtype, it may be associated with the opposite type, i.e. hypo-function, of the HPA-axis, similarly to PTSD. The purpose of this systematic review is to summarise existing studies addressing the abnormalities of the HPA-axis in melancholic and/or atypical depression.We conducted a systematic review in the literature by searching MEDLINE, PsycINFO, OvidSP and Embase databases until June 2017. The following search

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2017 Journal of Affective Disorders

2. Short-term and long-term measures of cortisol in saliva and hair in atypical and non-atypical depression. (PubMed)

Short-term and long-term measures of cortisol in saliva and hair in atypical and non-atypical depression. Atypical depression may show lowered rather than raised short-term cortisol levels. Atypical major depressive episodes (A-MDE) may also be more closely linked to environmental factors and show overlap with somatic symptom disorders. Hair specimens allow measuring long-term cortisol levels.Twenty-seven A-MDE and 44 NA-MDE patients and 40 matched controls were tested. Measures of hair

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2018 Acta Psychiatrica Scandinavica

3. Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression.

Melancholic and atypical depression as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression. Melancholic and atypical depression are widely thought to moderate or predict outcome of pharmacological and psychological treatments of adult depression, but that has not yet been established. This study uses the data from four earlier trials comparing cognitive behavior therapy (CBT) versus antidepressant medications (ADMs; and pill placebo when (...) available) to examine the extent to which melancholic and atypical depression moderate or predict outcome in an "individual patient data" meta-analysis.We conducted a systematic search for studies directly comparing CBT versus ADM, contacted the researchers, integrated the resulting datasets from these studies into one big dataset, and selected the studies that included melancholic or atypical depressive subtyping according to DSM-IV criteria at baseline (n = 4, with 805 patients). After multiple

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2018 Depression and anxiety

4. Prevalence and clinical features of atypical depression among patients with major depressive disorder in China. (PubMed)

Prevalence and clinical features of atypical depression among patients with major depressive disorder in China. Little is known about the demographic and clinical features of the atypical subtype of major depressive disorder (MDD) patients in China. This study set out to investigate the prevalence of atypical depression in MDD patients in China, and identify its demographic and clinical features.The study was conducted in 13 major psychiatric hospitals or in the psychiatric units of general (...) hospitals in China, and recruited a sample of 1172 patients diagnosed with MDD. The patients' demographic and clinical features and prescriptions of psychotropic drugs were collected using a standardized questionnaire designed for the study.The prevalence of atypical depression was 15.3%. In multiple logistic regression analyses, compared to the non-atypical depression patients, the atypical depression patients were more likely to have depressive episodes with suicide ideation and attempts (OR = 1.49

2018 Journal of Affective Disorders

5. Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey. (PubMed)

Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey. Depression is a heterogeneous disorder with multiple aetiological pathways and multiple therapeutic targets. This study aims to determine whether atypical depression (AD) characterized by reversed neurovegetative symptoms is associated with a more pernicious course and a different sociodemographic, lifestyle, and comorbidity profile than nonatypical depression (nonAD).Among (...) 157 366 adults who completed the UK Biobank Mental Health Questionnaire (MHQ), N = 37 434 (24%) met the DSM-5 criteria for probable lifetime major depressive disorder (MDD) based on the Composite International Diagnostic Interview Short Form. Participants reporting both hypersomnia and weight gain were classified as AD cases (N = 2305), and the others as nonAD cases (N = 35 129). Logistic regression analyses were conducted to examine differences between AD and nonAD in depression features

2019 Psychological Medicine

6. Depressive Symptoms are Frequent in Atypical Parkinsonian Disorders (PubMed)

Depressive Symptoms are Frequent in Atypical Parkinsonian Disorders To compare the incidence and prevalence of depressive symptoms in atypical parkinsonian (APD) syndromes versus Parkinson disease (PD).In a large retrospective patient cohort we analyzed the incidence and prevalence of depressive symptoms using the Beck Depression Inventory (BDI) and evaluated subjects longitudinally on subsequent visits. For individuals who followed in subsequent visits we calculated incidence rates in person (...) -years as a measure of incidence.We identified 361 patients with APD including Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), Multiple System Atrophy (MSA) and Dementia with Lewy Bodies (DLB), and 2352 PD controls. The mean BDI values were significantly higher in APD (F=14.19, p < 0.001). A significantly higher proportion of APD subjects screened positive for depressive symptoms both at initial and subsequent patient visits (p < 0.001), which appeared to be more severe

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2016 Movement disorders clinical practice

7. Cardiovascular Risk Factors as Differential Predictors of Incident Atypical and Typical Major Depressive Disorder in U.S. Adults. (PubMed)

Cardiovascular Risk Factors as Differential Predictors of Incident Atypical and Typical Major Depressive Disorder in U.S. Adults. Although the association between major depressive disorder (MDD) and future cardiovascular disease (CVD) is established, less is known about the relationship between CVD risk factors and future depression, and no studies have examined MDD subtypes. Our objective was to determine whether hypertension, tobacco use, and body mass index (BMI) differentially predict (...) atypical and typical MDD in a national sample of US adults.We examined prospective data from 22,915 adults with no depressive disorder history at baseline who participated in Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. CVD risk factors (Wave 1) and incident MDD subtypes (Wave 2) were determined by structured interviews.There were 252 patients with atypical MDD and 991 patients with typical MDD. In fully adjusted models, baseline

2018 Psychosomatic Medicine

8. Feeling left out: depressed adolescents may atypically recruit emotional salience and regulation networks during social exclusion (PubMed)

Feeling left out: depressed adolescents may atypically recruit emotional salience and regulation networks during social exclusion Depression is associated with negative attention and attribution biases and maladaptive emotion responsivity and regulation, which adversely impact self-evaluations and interpersonal relationships. Using functional magnetic resonance imaging, we investigated the neural substrates of these impairments. We compared neural activity recruited by 126 clinically depressed (...) and healthy adolescents (ages 11-17 years) during social exclusion (Exclusion > Inclusion) using Cyberball. Results revealed significant interaction effects within left anterior insula (AI)/inferior frontal gyrus and left middle temporal gyrus. Insula hyperresponsivity was associated with peer exclusion for depressed adolescents but peer inclusion for healthy adolescents. In additional, healthy adolescents recruited greater lateral temporal activity during peer exclusion. Complementary effect size

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2018 Social cognitive and affective neuroscience

9. Atypical depressive symptoms as a predictor of treatment response to exercise in Major Depressive Disorder. (PubMed)

Atypical depressive symptoms as a predictor of treatment response to exercise in Major Depressive Disorder. Effective treatment of Major Depressive Disorder (MDD) will require the development of alternative treatments and the ability for clinicians to match patients with the treatment likely to produce the greatest effect. We examined atypical depression subtype as a predictor of treatment response to aerobic exercise augmentation in persons with non-remitted MDD. Our results revealed a small (...) -to-moderate effect, particularly in a group assigned to high-dose exercise (semi-partial eta-squared =0.0335, p=0.0735), indicating that those with atypical depression tended to have larger treatment response to exercise. Through this hypothesis-generating analysis, we indicate the need for research to examine depression subtype, along with other demographic, clinical and biological factors as predictors of treatment response to exercise.Copyright © 2016 Elsevier B.V. All rights reserved.

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2016 Journal of Affective Disorders

10. Maladaptive mood repair, atypical respiratory sinus arrhythmia, and risk of a recurrent major depressive episode among adolescents with prior major depression. (PubMed)

Maladaptive mood repair, atypical respiratory sinus arrhythmia, and risk of a recurrent major depressive episode among adolescents with prior major depression. Because depressive illness is recurrent, recurrence prevention should be a mainstay for reducing its burden on society. One way to reach this goal is to identify malleable risk factors. The ability to attenuate sadness/dysphoria (mood repair) and parasympathetic nervous system functioning, indexed as respiratory sinus arrhythmia (RSA (...) as a latent construct), and resting RSA and RSA response to sadness induction (RSA profile), served to predict onset of first recurrent MDE by T2.Consistent with expectations, maladaptive mood repair predicted recurrent MDE, above and beyond T1 depression symptoms. Further, atypical RSA profiles at T1 were associated with high levels of maladaptive mood repair, which, in turn, predicted increased risk of recurrent MDE. Thus, maladaptive mood repair mediated the effects of atypical RSA on risk of MDE

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2016 Psychological Medicine

11. Genetic Association of Major Depression With Atypical Features and Obesity-Related Immunometabolic Dysregulations. (PubMed)

Genetic Association of Major Depression With Atypical Features and Obesity-Related Immunometabolic Dysregulations. The association between major depressive disorder (MDD) and obesity may stem from shared immunometabolic mechanisms particularly evident in MDD with atypical features, characterized by increased appetite and/or weight (A/W) during an active episode.To determine whether subgroups of patients with MDD stratified according to the A/W criterion had a different degree of genetic overlap (...)  × 10-3) and leptin (OR, 1.09; 95% CI, 1.06-1.12; P = 1.7 × 10-3).The phenotypic associations between atypical depressive symptoms and obesity-related traits may arise from shared pathophysiologic mechanisms in patients with MDD. Development of treatments effectively targeting immunometabolic dysregulations may benefit patients with depression and obesity, both syndromes with important disability.

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2017 JAMA psychiatry (Chicago, Ill.)

12. Musculoskeletal Pain in Melancholic and Atypical Depression. (PubMed)

Musculoskeletal Pain in Melancholic and Atypical Depression. Pain and depressive disorders often present together, but little is known about the prevalence of pain in depression subgroups. The objective of this study was to examine the possible differences in the prevalence of musculoskeletal pain between participants in melancholic and atypical depression subgroups.Cross-sectional study.Depression nurse case managers where depression patients receive treatment in primary health (...) care.Participants included 413 depression patients and 401 controls.Depressive symptoms were determined with the Beck Depression Inventory (BDI-21), and diagnosis of depression was confirmed with the Mini-International Neuropsychiatric Interview (MINI). The participants were dichotomized into subgroups with melancholic depression (n = 269), atypical depression (n = 144), and controls (n = 401). Musculoskeletal pain was identified during last four weeks. Participants were enrolled in the study between 2008

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2017 Pain Medicine

13. Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. (PubMed)

Safety and efficacy of adjunctive second-generation antidepressant therapy with a mood stabiliser or an atypical antipsychotic in acute bipolar depression: a systematic review and meta-analysis of randomised placebo-controlled trials. Although mania and hypomania define bipolar disorder, depressive episodes are more common and impairing, with few proven treatments. Adjunctive therapy with second-generation antidepressants is widely used to treat acute bipolar depression, but their efficacy (...) and safety remain controversial.In this systematic review and meta-analysis, we searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov from inception to Jan 31, 2016, for randomised, double-blind, placebo-controlled trials of second-generation antidepressants adjunctive to a mood stabiliser or an antipsychotic in patients with acute bipolar depression. We extracted data from published reports. The primary outcome was change in clinician-rated depressive

2017 The Lancet. Psychiatry

14. Practitioner review: The effects of atypical antipsychotics and mood stabilisers in the treatment of depressive symptoms in paediatric bipolar disorder. (PubMed)

Practitioner review: The effects of atypical antipsychotics and mood stabilisers in the treatment of depressive symptoms in paediatric bipolar disorder. The management of depressive and mixed symptoms in children and adolescents with bipolar disorder (BD) remains a matter of debate. The goal of this review is, thus, to systematically examine the impact of atypical antipsychotics (AAPs) and mood stabilisers in the treatment of bipolar depression and/or mixed states.A literature search (...) was conducted for studies assessing the efficacy of pharmacological treatments for bipolar disorder type I, type II and not otherwise specified with a recent depressive, mixed or manic episode (with depressive symptoms) following DSM-IV criteria in children and adolescents as either acute or maintenance treatment. The databases searched were PubMed/Medline, Google Scholar and Tripdatabase, as well as ClinicalTrials.gov. The search was limited to clinical trials, systematic reviews, meta-analyses and open

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2017 Journal of Child Psychology and Psychiatry

15. Lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression: A systematic review and network meta-analysis. (PubMed)

Lurasidone compared to other atypical antipsychotic monotherapies for bipolar depression: A systematic review and network meta-analysis. To assess the efficacy and tolerability of lurasidone versus other atypical antipsychotic monotherapy agents in patients with bipolar depression, using a Bayesian network meta-analysis.Fourteen randomised clinical trials (6221 patients) of lurasidone, quetiapine (extended release and immediate release), aripiprazole, olanzapine, and ziprasidone for bipolar (...) depression were included. Efficacy assessments included change in the Montgomery-Åsberg Depression Rating Scale (MADRS), rates of response (≥50% improvement in MADRS) and remission (MADRS ≤12 at study endpoint), and change in the Clinical Global Impressions-Bipolar Disorder-Severity (CGI-BP-S) scale. Tolerability outcomes included weight, somnolence, extrapyramidal symptoms (EPS), and all-cause discontinuation. Changes from baseline or odds ratios (OR) with 95% credible intervals (CrI) were

2017 The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry

16. The modulation of adult neuroplasticity is involved in the mood-improving actions of atypical antipsychotics in an animal model of depression (PubMed)

The modulation of adult neuroplasticity is involved in the mood-improving actions of atypical antipsychotics in an animal model of depression Depression is a prevalent psychiatric disorder with an increasing impact in global public health. However, a large proportion of patients treated with currently available antidepressant drugs fail to achieve remission. Recently, antipsychotic drugs have received approval for the treatment of antidepressant-resistant forms of major depression (...) (a classical antipsychotic) and clozapine (an atypical antipsychotic). We demonstrated that clozapine improved both measures of depressive-like behavior (behavior despair and anhedonia), whereas haloperidol aggravated learned helplessness in the forced-swimming test and behavior flexibility in a cognitive task. Importantly, an upregulation of adult neurogenesis and neuronal survival was observed in animals treated with clozapine, whereas haloperidol promoted a downregulation of these processes. Furthermore

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2017 Translational psychiatry

17. Atypical depression: current perspectives (PubMed)

Atypical depression: current perspectives The history and present status of the definition, prevalence, neurobiology, and treatment of atypical depression (AD) is presented. The concept of AD has evolved through the years, and currently, in Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, the specifier of depressive episode with atypical feature is present for both diagnostic groups, that is, depressive disorders and bipolar and related disorders. This specifier (...) includes mood reactivity, hyperphagia, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. Prevalence rates of AD are variable, depending on the criteria, methodology, and settings. The results of epidemiological studies using DSM criteria suggest that 15%-29% of depressed patients have AD, and the results of clinical studies point to a prevalence of 18%-36%. A relationship of AD with bipolar depression, seasonal depression, and obesity has also been postulated. Pathogenic research

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2017 Neuropsychiatric disease and treatment

18. Atypical antipsychotics as add-on treatment in late-life depression (PubMed)

Atypical antipsychotics as add-on treatment in late-life depression Second-generation antipsychotics (SGAs) have been used in the augmentation of treatment-resistant depression. However, little is known about their effectiveness, tolerability, and adverse events in the treatment of late-life depression, which were the aim of this study.The retrospective data of patients aged >65 years who had a major depressive episode with inadequate response to antidepressant treatment and had adjuvant SGA (...) ±1.76 mg for olanzapine. The Geriatric Depression Scale scores of all patients were significantly decreased in the fourth week and were significant in the aripiprazole group (P=0.02). Of the 35 patients, 23 (65.7%) patients discontinued the study within 12 weeks. The frequency of adverse events was similar in all SGAs, and the most common were sedation, dizziness, constipation, and orthostatic hypotension with quetiapine, and akathisia and headache because of aripiprazole.This study indicates

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2016 Clinical interventions in aging

19. Neuropsychological Changes in Melancholic and Atypical Depression: A Systematic Review. (PubMed)

Neuropsychological Changes in Melancholic and Atypical Depression: A Systematic Review. There is not a consensus as to whether neuropsychological profiling can distinguish depressive subtypes. We aimed to systematically review and critically analyse the literature on cognitive function in patients with melancholic and atypical depression. We searched in databases PubMed, SCOPUS, Web of Knowledge and PsycInfo for papers comparing the neuropsychological performance of melancholic patients (MEL (...) ) to non-melancholic depressive patients (NMEL), including atypical depressives, and healthy controls (HC). All studies were scrutinised to determine the main methodological characteristics and particularly possible sources of bias influencing the results reported, using the STROBE statement checklist. We also provide effect size of the results reported for contrasts between MEL; patients and NMEL patients. Seventeen studies were included; most of them demonstrated higher neuropsychological impairments

2016 Neuroscience and biobehavioral reviews

20. Atypical reactivity of heart rate variability to stress and depression across development: Systematic review of the literature and directions for future research. (PubMed)

Atypical reactivity of heart rate variability to stress and depression across development: Systematic review of the literature and directions for future research. Heart rate variability has received growing attention in the depression literature, with several recent meta-analyses indicating that lower resting heart rate variability is associated with depression. However, the role of fluctuations in heart rate variability (or reactivity) in response to stress in depression remains less clear (...) . The present review provides a systematic examination of the literature on heart rate variability reactivity to a laboratory-induced stressor task and depression, including 26 studies of reactivity in heart rate variability and clinical depression, remitted (or history of) depression, and subthreshold depression (or symptom-level depression) among adults, adolescents, and children. In addition to reviewing the findings of these studies, methodological considerations and conceptual gaps in the literature

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2016 Clinical psychology review

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