Translating the evidence on atypical depression into clinical practice

Subtypes of depression need to be recognized and diagnosed in order to properly treat patients who have depression but present with different symptoms from one another. Different pharmacotherapuetic strategies may work better for different subtypes. Selective serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) have been studied for the treatment of atypical depression. To date, MAOIs have been shown to be the most efficacious agents in treating atypical depression; however, many MAOIs nonselectively and irreversibly inhibit both MAO substrates, require tyramine-restricted diets, and may produce weight gain, cardiovascular side effects, or sexual dysfunction. A newer MAOI, the transdermal formulation of selegiline, may provide all of the efficacy of the older MAOIs in treating atypical depression without causing as great of adverse events and no diet restrictions.