Melancholia and atypical depression in the Zurich study:: epidemiology, clinical characteristics, course, comorbidity and personality

Objective: A comparison of psychiatric, psychological and somatic characteristics in specified subgroups of major depressive episodes (MDE). Method: In a stratified community sample of young adults investigated prospectively from age 20/21 to 40/41, we defined four MDE subgroups: i) DSM-IV melancholia or atypical depression (the 'combined group'), ii) pure melancholia, iii) pure atypical depression, and iv) unspecified MDE. Results: The cumulative incidence rates of the four groups were 4.1%, 7.1%, 3.5% and 8.2% respectively. Women were over-represented in the combined and atypically depressed group. In 56 of 117 (47.9%) cases, melancholia was longitudinally associated with atypical MDE (n = 84) (OR = 11.9). Conclusion: Melancholic MDE was more severe than atypical MDE although the two groups shared many characteristics. The longitudinal overlap of melancholia with atypical depression in almost half of all cases calls for comparative analyses of combined, pure and unspecified MDE.