Depressive subtypes and efficacy of antidepressive pharmacotherapy

Efficacy studies suggest that all kinds of treatment have similar efficacy. For instance, according to a meta-analysis from 102 randomised controlled trials in major depression, there is no overall difference in efficacy between SSRIs and TCAs. Taking into consideration the pathophysiological heterogeneity of affective disorders involving a number of neurotransmitters, the different pharmacodynamic profiles of the antidepressant compounds, and the large variety of presentations of depressive illness, it is very simplistic to suppose that all classes of antidepressants are equally effective. Meanwhile, the development of antidepressants with different mechanisms of action provides the opportunity to evaluate whether certain relevant subtypes of depressed patients, based on specific patterns of symptoms, respond preferentially to one class of antidepressants compared with another. The aim of this paper is to review the relationship between the depressive subtypes included in the DSM-IV (melancholic depression, atypical depression, bipolar depression, psychotic bipolar and dysthymia) and the efficacy of antidepressant treatment.