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Atypical Depression, Panic Attacks, and Response to Imipramine and Phenelzine:  A Replication

Frederic M. Quitkin, MD; Patrick J. McGrath, MD; Jonathan W. Stewart, MD; Wilma Harrison, MD; Elaine Tricamo, RN; Steven G. Wager, MD; Katja Ocepek-Welikson, MPhil; Edward Nunes, MD; Judith G. Rabkin, PhD; Donald F. Klein, MD
Arch Gen Psychiatry. 1990;47(10):935-941. doi:10.1001/archpsyc.1990.01810220051006.
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• In an initial study with 120 patients with reactive mood and associated atypical symptoms, phenelzine sulfate was superior to imipramine hydrochloride and placebo. Since their response to phenelzine appears to be unique, this suggests that atypical depression may be a distinct subgroup of unipolar depressive illness. Unexpectedly, the benefit of antidepressants was limited to patients who also had spontaneous panic attacks. To help establish the validity of this syndrome, a new sample of 90 atypical depressives was studied. The clinical and demographic characteristics of the original and replication sample were virtually identical at baseline. In addition, the treatment response with either placebo, imipramine, or phenelzine was also indistinguishable in the two patient groups. The outcome in the replication study supports the hypothesis that this may be a distinct unipolar depressive subgroup. In the replication sample, a history of panic attacks did not appear to be a relevant predictor. We discuss the explanations for this discrepancy in the two patient samples.

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