Treatment for atypical depression needs to be revised based on new knowledge and drugs to improve its effectiveness.

The present study compared the efficacy and safety of the therapy for atypical depression (AtD) in the structure of bipolar affective disorder (BAD), recurrent depressive disorder (RDR), and psychogenic depression (PD).

The study examined 77 patients with AtD, of which 35 were with bipolar disorder, 18 with RDR, and 24 with PD. It administered monotherapy with an antidepressant or a mood stabilizer, or a combination of antidepressant and antipsychotic, antidepressant and mood stabilizer, mood stabilizer and antipsychotic, as well as a combination of an antidepressant, antipsychotic and mood stabilizer in patients in all three groups.

The study found that agomelatine was the most frequently used drug (27.3%) and effectively lowered MADRS in all groups (monotherapy and in combination with other drugs). In the PD group, escitalopram and vortioxetine showed high effectiveness. Among the antipsychotics combined with antidepressants, sulpiride demonstrated maximum effectiveness. On comparing the tolerance of antidepressants in all groups best results (by the CGI scale) were shown by agomelatine and venlafaxine.

Thus, for effective and safe treatment of atypical depression, the best strategy is to use modern antidepressant, which does not augment the symptoms of the atypical spectrum and, if required, can be supplemented with some antipsychotics.

Psychiatry. 2022;65(S1):S565-S566. doi:10.1192/j.eurpsy.2022.1448