Purpose. Neurobiological abnormalities underlying atypical depression have previously been suggested. The purpose of this study was to explore differences at functional brain imaging between depressed patients with and without atypical features and healthy controls.
Methods. 23 out-patients with chronic depressive disorder recruited from a service for patients with audiological symptom were investigated. Eleven fulfilled the DSM-IV criteria for atypical depression (Mood reactivity and two among weight gain, hypersomnia, leaden paralysis and interpersonal rejection sensitivity). Twenty-three healthy subjects served as controls. Voxel-based analysis was applied to explore 99mTc-HMPAO uptake differences between groups.
Results. Patients in the atypical group had a higher prevalence of bilateral hearing impairment, and higher depression and somatic distress ratings at the time of SPECT. Significantly higher tracer uptake was found bilaterally in the atypical patients as compared to the non-atypicals in the sensorimotor (Brodmann areas, BA1-3) and premotor cortex in the superior frontal gyri (BA6), in the middle frontal cortex (BA8), in the parietal associative cortex (BA5, BA7) and in the inferior parietal lobule (BA40). Significantly lower tracer distribution was found in right hemisphere in the non-atypicals compared to the controls in BA6, BA8, BA44, BA45 and BA46 in the frontal cortex, in the orbito-frontal cortex (BA11, BA47), in the postcentral parietal cortex (BA2), and in the multimodal association parietal cortex (BA40).
Conclusion. The differences found between atypical and non-atypical depressed patients suggest differential neurobiological substrates in these patients groups. The putative links with the clinical features of atypical depression are discussed. These findings encourage the use of functional neuroimaging in psychiatric disorders.
