Atypical depression is more common than melancholic in fibromyalgia: an observational cohort study

BMC Musculoskeletal Disorders

Research Article

Rachel L Ward¹  Rebecca L Ross¹  Lisa J Wood²  Kim D Jones³  Robert M Bennett³ 

[1] Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Road, 97239, Portland, Oregon, USA;Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Road, 97239, Portland, Oregon, USA;Oregon Health & Science University Cancer Institute, Division of Hematology and Medical Oncology, 3181 SW Sam Jackson Park Road, 97239, Portland, Oregon, USA;Oregon Health & Science University, School of Nursing, 3455 SW US Veterans Hospital Road, 97239, Portland, Oregon, USA;Oregon Health & Science University, School of Medicine, 3181 SW Sam Jackson Park Road, 97239, Portland, Oregon, USA;

关键词: Major Depressive Disorder;    Fibromyalgia Impact Questionnaire;    Atypical Depression;    Melancholic Depression;    Mood Reactivity;   

DOI  :  10.1186/1471-2474-11-120

 received in 2009-08-18, accepted in 2010-06-14,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundIt has been postulated that atypical and melancholic depression subtypes exist in depressed fibromyalgia (FM) patients, yet no study has empirically tested this hypothesis. The purpose of this study is to determine whether major depressive disorder (MDD) with atypical features and MDD with melancholic features occurs in a FM sample and to describe their demographic, clinical and diagnostic characteristics.MethodsAn observational cohort study using a descriptive cross-sectional design recruited a convenience sample of 76 outpatients with FM from an academic Rheumatology clinic and a community mental health practice. Diagnoses of FM were confirmed using the 1990 ACR classification guidelines. Diagnoses of MDD and diagnostic subtypes were determined using the DSM-IV-TR criteria. Clinical characteristics were measured using the Fibromyalgia Impact Questionnaire, Structured Interview Guide for the Hamilton Depression Rating Scale with Atypical Depression Supplement and other standardized instruments. Odds ratios were computed on subtype-specific diagnostic criteria. Correlations assessed associations between subtype diagnoses and diagnostic criteria.ResultsOf the 76 subjects with FM, 11.8% (n = 9) were euthymic, 52.6% (n = 40) met diagnostic criteria for MDD with atypical features and 35.6% (n = 27) for MDD with melancholic features. Groups did not differ on demographic characteristics except for gender (p = 0.01). The non-depressed and atypical groups trended toward having a longer duration of FM symptoms (18.05 yrs. ± 12.83; 20.36 yrs. ± 15.07) compared to the melancholic group (14.11 yrs. ± 8.82; p = 0.09). The two depressed groups experienced greater severity on all clinical features compared to the non-depressed group. The atypical group did not differ clinically from the melancholic group except the latter experienced greater depression severity (p = 0.001). The atypical group demonstrated the highest prevalence and correlations with atypical-specific diagnostic criteria: (e.g., weight gain/ increased appetite: OR = 3.5, p = 0.02), as did the melancholic group for melancholic-specific criteria: (e.g., anhedonia: OR = 20, p < 0.001).ConclusionDepressed fibromyalgia patients commonly experience both atypical and melancholic depressive features; however, in this study, atypical depression was 1.5 times more common than melancholic depression. This finding may have significant research and clinical implications.

【 授权许可】

CC BY   
© Ross et al; licensee BioMed Central Ltd. 2010