Clinical and demographic features of atypical depression in outpatients with major depressive disorder: Preliminary findings from STAR*D

Objective: To determine the frequency and demographic and clinical characteristics of depression with atypical features in a broadly representative sample of outpatients. Method: Data derived from the first 1500 patients with DSM-IV major depressive disorder enrolled in the Sequenced Treatment Alternatives to Relieve Depression trial at 41 primary care and nonresearch psychiatric outpatient clinics. An algorithm based on the 30-item Inventory of Depressive Symptomatology-Clinician Rating (IDS-C30) determined presence or absence of depression with atypical features. Odds ratios determined whether a variety of demographic and clinical parameters differed between patients meeting and not meeting atypical criteria. Results: Over 18% of the sample met criteria for atypical features based on items from the IDS-C30. The atypical group was more likely to be female and have an earlier age at onset, greater comorbidity with anxiety symptoms, and greater symptom severity compared with the nonatypical group. Conclusion: Previously identified features of atypical depression were confirmed in this large and broadly representative, nonresearch clinical population.