Bipolar Disorders: Mixed States, Rapid-Cycling, and Atypical Forms

141 Atypical depression and bipolar spectrummedian age of onset of 52, which is near the median age of onset of menopause, 51years) found more AD (53.2% versus 31.6%, P ¼ 0.0019) and BP-II (47.7% versus26.9%, P ¼ 0.0026) before 40 years (in males there was no significant difference inthe BP-II frequency, while AD frequency was significantly reduced after age 40),suggesting that menopause may change the picture of depression (Benazzi,2000h).More recent, published, studies of the author on AD have focused on a definitionof AD based only on the reversed vegetative symptoms (oversleeping,overeating, weight gain: Benazzi, 2002f), on the impact of AD on trials of antidepressantsin BP-II (Benazzi, 2004a), on supporting the subtyping of AD into anearly-onset, chronic subtype versus a non-early-onset, non-chronic subtype(Benazzi, 2004b), on the normal-like distribution of atypical symptoms betweenBP-II and UP MDE, supporting a continuity between the two disorders by findingno zone of rarity (which would be expected because AD is more common in BP-II:Benazzi, 2003c), on testing the DSM-IV definition of AD (Benazzi, 2003d), and onfurther testing the predictive power for BP-II of AD versus other bipolor validatorssuch as BP family history and depressive mixed state (Benazzi, 2003e).The author’s last sample study on atypical depressionStudy methodsInterviewerThe interviewer was a senior clinical and mood disorder research psychiatrist.Study settingThe study was carried out in a private outpatient psychiatry center (a University ofCalifornia in San Diego (USA) collaborating center). Private practice is morerepresentative of mood-disorder patients in Italy, where it is the first (or the second,after family doctors) line of treatment of mood disorders, and national mentalhealth services and university centers usually treat the most severe patients. Mostindividuals can be visited by a private psychiatrist in Italy (reducing a possibleselection bias). Authorities believe that mood-disorder patients in tertiary-carecenters may not be representative of patients who are usually treated in clinicalpractice (Akiskal and Pinto, 1999; Goldberg and Kocsis, 1999; Ghaemiet al., 2000;Post et al., 2001).Patients and interviewConsecutive UP (major depressive disorder (MDD), MDD superimposed ondysthymic disorder) and BP-II outpatients, presenting spontaneously for MDE