Meta-review of depressive subtyping models

Harald, Baumeister; Gordon, Parker

doi:10.1016/j.jad.2011.07.015

Cited by 328Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Disorders

Meta-review of depressive subtyping models

Harald, Baumeister, Gordon, Parker·2012·Journal of Affective Disorders

DOI 10.1016/j.jad.2011.07.015

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Abstract

Background Increasing dissatisfaction with the non-specificity of major depression has led many to propose more specific depressive subtyping models. The present meta-review seeks to map dominant depressive subtype models, and highlight definitions and overlaps.Methods A database search in Medline and EMBASE of proposed depressive subtypes, and limited to reviews published between 2000 and 2011, was undertaken. Of the more than four thousand reviews, 754 were judged as potentially relevant and provided the base for the present selective meta-review.Results Fifteen subtype models were identified. The subtypes could be divided into five molar categories of (1) symptom-based subtypes, such as melancholia, psychotic depression, atypical depression and anxious depression, (2) aetiologically-based subtypes, exemplified by adjustment disorders, early trauma depression, reproductive depression, perinatal depression, organic depression and drug-induced depression, (3) time of onset-based subtypes, as illustrated by early and late onset depression, as well as seasonal affective disorder, (4) gender-based (e.g. female) depression, and (5) treatment resistant depression. An overview considering definition, bio-psycho-social correlates and the evidence base of treatment options for each subtype is provided.Limitations Despite the large data base, this meta-review is nevertheless narrative focused.Conclusions Subtyping depression is a promising attempt to overcome the non-specificity of many diagnostic constructs such as major depression, both in relation to their intrinsic non-specificity and failure to provide treatment-specific information. If a subtyping model is to be advanced it would need, however, to demonstrate differential impacts of causes and treatments.

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For analyses of moderators, P-values were corrected following Bonferroni-Holm.
“Since these analyses of moderators are explorative in nature, P -values were corrected following Bonferroni-Holm. 31”
From Childhood maltreatment and characteristics of adult depression: Meta-analysis (2017) · cites this paper as [31]
Several studies have reported that subthreshold depressions did not differ from diagnosable depression with respect to variables such as risk for future depressive episodes, family history of mental illness, psychiatric and physical comorbidity, and functional impairment.
“Several studies 52,53 have reported that subthreshold depressions (i.e., conditions characterized by the presence of less than five depressive symptoms or signs) did not differ from diagnosable depression with respect to variables such as the risk for future depressive episodes, the family history of mental illness (including depression), psychiatric and physical comorbidity, and functional impair”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [52]
FCS alterations in these regions have been proven to be related to regulation of widespread cognitive, emotional, and executive control functions in MDD.
“The FCS alterations in these regions have been proven to be related to the regulation of widespread cognitive, emotional, and executive control functions in patients with MDD [6, 42-50].”
From Mapping neurophysiological subtypes of major depressive disorder using normative models of the functional connectome (2023) · cites this paper as [6]

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Various forms of depression
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Method
The Neurobiology of Postpartum Depression
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“Such neglect is likely to reflect multiple reasons – including the lower scientific appeal of minor disorders – but is most commonly viewed as reflecting inadequate operationalisation of adjustment disorders and poor delineation of adjustment disorders from normal stress responses and from other specific disorders (Ba…”
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Treatment-Resistant Depression: Critique of Current Approaches
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Somatic Treatment of Psychotic Depression: Review and Recommendations for Practice
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Atypical Depression: Useful Concept, but it's Time to Revise the DSM-IV Criteria
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Atypical depression: current status and relevance to melancholia
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Biological and Psychological Mechanisms of Seasonal Affective Disorder: A Review and Integration
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Antidepressant prevention of postnatal depression
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Defining anxious depression: going beyond comorbidity
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Struggle for Subtypes in Primary and Secondary Depression and Their Mode-Specific Treatment or Healing
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Pharmacologic Treatment for Postpartum Depression: A Systematic Review
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Factor study of the Hamilton Rating Scale for Depression and the Bech Melancholia Scale
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Perimenopause and depression: strength of association, causal mechanisms and treatment recommendations
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Complementary and alternative medicine for perinatal depression
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Is psychotherapy an effective treatment for melancholia and other severe depressive states?
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Pharmacological treatment for psychotic depression
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The efficacy of n-3 fatty acids DHA and EPA (fish oil) for perinatal depression
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Issues for DSM-V: Seasonal Affective Disorder and Seasonality
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Anxious depression: Clinical features and treatment
Rao, S. D. (2009) · Current Psychiatry Reports · doi:10.1007/s11920-009-0065-2 · Cited by 49 · see citing works
Hormonal therapy and depression: Are we overlooking an important therapeutic alternative?
Ancelin, M., Scali, J., & Ritchie, K. A. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.12.019 · Cited by 49 · see citing works
Unkind cytokines: Current evidence for the potential role of cytokines in immune-mediated depression
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Essentials of Psychiatry
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Differential Response to Combined Treatment in Patients With Psychotic Versus Nonpsychotic Major Depression
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Women and Depression: A 30 Year Learning Curve
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Clinical interventions for late-life anxious depression
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Does gender influence response to differing psychotherapies by those with unipolar depression?
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The Spectrum of Adjustment Disorders: Too Broad to be Clinically Helpful
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Pharmacotherapy of postpartum depression
di Scalea, T. L., & Wisner, K. L. (2009) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656560903277202 · Cited by 43 · see citing works
Deep brain stimulation in the treatment of depression
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Depression and the pitfalls of causality: Implications for DSM-V
Pies, R. W. (2008) · Journal of Affective Disorders · doi:10.1016/j.jad.2008.11.009 · Cited by 41 · see citing works
Inching toward Bethlehem: Mapping melancholia
Parker, G. B., Fletcher, K., Barrett, M., Synnott, H., Breakspear, M. J., Rees, A.-M., & Hadži-Pavlović, D. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.10.001 · Cited by 41 · see citing works
The facets of melancholia
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The impact of clinical significance criteria on subthreshold depression prevalence rates
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Evolution is the scientific foundation for diagnosis: psychiatry should use it.
Nesse, R. M. (2007) · PubMed Central · Cited by 39 · see citing works
Are oestrogens useful for the treatment of depression in women?
Studd, J. W. W., & Panay, N. (2008) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2008.11.001 · Cited by 39 · see citing works
What is this thing called “SAD”? A critique of the concept of seasonal affective disorder
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Psychosomatic aspects of Cushing’s syndrome
Sonino, N., Fallo, F., & Fava, G. (2010) · Reviews in Endocrine & Metabolic Disorders · doi:10.1007/s11154-009-9123-7 · Cited by 38 · see citing works
Women's Reproductive Related Disorders (RRDs)
Halbreich, U. M. (2009) · Journal of Affective Disorders · doi:10.1016/j.jad.2009.05.018 · Cited by 38 · see citing works
Modelling and Managing the Depressive Disorders: A Clinical Guide
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Antenatal Depression: Navigating the Treatment Dilemmas
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Update on Drug-Induced Depression in the Elderly
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Emanuel Miller Lecture: Early onset depressions – meanings, mechanisms and processes
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Atypical Depression: A Valid Subtype?
Parker, G. B. (2007) · The Primary Care Companion to The Journal of Clinical Psychiatry · Cited by 34 · see citing works
Through a Glass Darkly: The Disutility of the DSM Nosology of Depressive Disorders
Parker, G. B. (2006) · The Canadian Journal of Psychiatry · doi:10.1177/070674370605101403 · Cited by 33 · see citing works
It is too early for adjusting the adjustment disorder category
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The treatment of psychotic major depression: Is there a role for adjunctive psychotherapy?
Gaudiano, B. A., Miller, I. W., & Herbert, J. D. (2007) · Psychotherapy and Psychosomatics · doi:10.1159/000104703 · Cited by 31 · see citing works
Social neuroscience of child and adolescent depression
Miller, A. (2007) · Brain and Cognition · doi:10.1016/j.bandc.2006.02.008 · Cited by 30 · see citing works
Olanzapine/Fluoxetine
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Recent advances in poststroke depression
Tharwani, H. M., Yerramsetty, P., Mannelli, P., Patkar, A. A., & Masand, P. S. (2007) · Current Psychiatry Reports · doi:10.1007/s11920-007-0023-9 · Cited by 29 · see citing works
An Overview of Seasonal Affective Disorder and its Treatment Options
Howland, R. H. (2009) · The Physician and Sportsmedicine · doi:10.3810/psm.2009.12.1748 · Cited by 28 · see citing works
Finasteride‐induced depression: new insights into possible pathomechanisms
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Psychotic (Delusional) Major Depression: New Vistas
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Biological Markers of Atypical Depression
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Psychotic Major Depression
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A Second Thought on Subtyping Major Depression
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Should we stop using tricyclic antidepressants in pregnancy?
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Neuroimaging in late-life depression
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Role of Omega‐3 Fatty Acids for Prevention or Treatment of Perinatal Depression
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Antidepressant Prevention of Postnatal Depression
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Use of Endocrine Hormones for Treating Depression
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Specificity of depression following an acute coronary syndrome to an adverse outcome extends over five years
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Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
The Multifaceted Role of the Ventromedial Prefrontal Cortex in Emotion, Decision Making, Social Cognition, and Psychopathology
Hiser, J., & Koenigs, M. (2018) · Biological Psychiatry · doi:10.1016/j.biopsych.2017.10.030 · Cited by 972 · see citing works
Childhood maltreatment and characteristics of adult depression: Meta-analysis
Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017) · British Journal of Psychiatry · doi:10.1192/bjp.bp.115.180752 · Cited by 822 · see citing works
“We therefore implemented the RVE method also used for research questions 4–6.”
Evidence for a differential role of HPA-axis function, inflammation and metabolic syndrome in melancholic versus atypical depression
Lamers, F., Vogelzangs, N., Merikangas, K. R., de Jonge, P., Beekman, A. T. F., & Penninx, B. W. J. H. (2013) · Molecular Psychiatry · doi:10.1038/mp.2012.144 · Cited by 691 · see citing works
“12 In the past, substantial research has been devoted to the identiﬁcation of subtypes of depression 20 based on clinical correlates, treatment response or observed symptom proﬁles.”
Background
The Impact of Individual Depressive Symptoms on Impairment of Psychosocial Functioning
Fried, E. I., & Nesse, R. M. (2014) · PLoS ONE · doi:10.1371/journal.pone.0090311 · Cited by 419 · see citing works
Internet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis
Josephine, K., Josefine, L., Philipp, D., David, E., & Harald, B. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.07.021 · Cited by 341 · see citing works
Atypical depression and non-atypical depression: Is HPA axis function a biomarker? A systematic review
Juruena, M. F., Bocharova, M., Agustini, B., & Young, A. H. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.09.052 · Cited by 365 · see citing works
Is there a “metabolic-mood syndrome”? A review of the relationship between obesity and mood disorders
Mansur, R. B., Brietzke, E. M., & McIntyre, R. S. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2014.12.017 · Cited by 325 · see citing works
An Evolutionary Life History Framework for Psychopathology
Giudice, M. D. (2014) · Psychological Inquiry · doi:10.1080/1047840x.2014.884918 · Cited by 316 · see citing works
“Bejerot, S. (2007). An autistic dimension: A proposed subtype of obsessive-compulsive disorder.”
Background
Depression is more than the sum score of its parts: individual DSM symptoms have different risk factors
Fried, E. I., Nesse, R. M., Zivin, K., Guille, C., & Sen, S. (2013) · Psychological Medicine · doi:10.1017/s0033291713002900 · Cited by 300 · see citing works
“For diagnostic purposes, the nine symptoms that compose the DSM-5 criteria for major depressive disorder (MDD) are assumed to be interchangeable indicators of one underlying disorder, implying that they should all have similar risk factors.”
Background
Revisiting the theoretical and methodological foundations of depression measurement
Fried, E. I., Flake, J. K., & Robinaugh, D. J. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00050-2 · Cited by 285 · see citing works
Dissecting diagnostic heterogeneity in depression by integrating neuroimaging and genetics
Buch, A. M., & Liston, C. M. (2020) · Neuropsychopharmacology · doi:10.1038/s41386-020-00789-3 · Cited by 271 · see citing works
“Subtyping on clinical symptom profiles Pioneering early efforts to define depression subtypes and parse diagnostic heterogeneity tended to subgroup patients with distinct co-occurring symptom patterns and then test for neurobiological correlates of these subgroups, which could potentially be used as biomarkers for aid…”
Background
Data-driven biological subtypes of depression: Systematic review of biological approaches to depression subtyping
Beijers, L., Wardenaar, K. J., van Loo, H. M., & Schoevers, R. A. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0385-5 · Cited by 240 · see citing works
Meta-analytic evidence for neuroimaging models of depression: State or trait?
Graham, J., Salimi‐Khorshidi, G., Hagan, C. C., Walsh, N., Goodyer, I. M., Lennox, B., & John Suckling, A. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.07.002 · Cited by 231 · see citing works
“There is a large degree of variation in the phenotypic presentation of MDD with, for example, melancholia, psychotic depression and post-natal depression felt to represent distinct sub-types of the condition (Harald and Gordon, 2012).”
Background
The vigilance regulation model of affective disorders and ADHD
Hegerl, U., & Hensch, T. (2014) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.10.008 · Cited by 212 · see citing works
Antidepressive Mechanisms of Probiotics and Their Therapeutic Potential
Yong, S. J., Tong, T., Chew, J., & Lim, W. L. (2020) · Frontiers in Neuroscience · doi:10.3389/fnins.2019.01361 · Cited by 217 · see citing works
Depression and diabetes: treatment and health-care delivery
Petrak, F., Baumeister, H., Skinner, T. C., Brown, A. D. H., & Holt, R. I. G. (2015) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(15)00045-5 · Cited by 193 · see citing works
Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder
Kessler, R. C., van Loo, H. M., Wardenaar, K. J., Bossarte, R. M., Brenner, L. A., Ebert, D. D., de Jonge, P., Nierenberg, A. A., Rosellini, A. J., Sampson, N. A., et al. (2016) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796016000020 · Cited by 193 · see citing works
Psychological and pharmacological interventions for depression in patients with diabetes mellitus and depression
Baumeister, H., Hutter, N., & Bengel, J. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008381.pub2 · Cited by 188 · see citing works
Self-citation
Effect of tyrosine supplementation on clinical and healthy populations under stress or cognitive demands—A review
Jongkees, B. J., Hommel, B., Kühn, S., & Colzato, L. S. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.08.014 · Cited by 177 · see citing works
“lack of motivation versus anxiety) and these may differ per individual patient (Harald and Gordon, 2012).”
Background
Depression Subtypes in Predicting Antidepressant Response: A Report From the iSPOT-D Trial
Arnow, B. A., Blasey, C., Williams, L. M., Palmer, D. M., Rekshan, W., Schatzberg, A. F., Etkin, A., Kulkarni, J., Luther, J. F., & Rush, A. J. (2015) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.14020181 · Cited by 175 · see citing works
“First, the three symptom-based subtypes (9) were developed independently and are not necessarily mutually exclusive.”
Background
Irritable Mood as a Symptom of Depression in Youth: Prevalence, Developmental, and Clinical Correlates in the Great Smoky Mountains Study
Stringaris, A. K., Maughan, B., Copeland, W., Costello, E. J., & Angold, A. C. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.05.017 · Cited by 165 · see citing works
An adaptationist perspective on the etiology of depression
Durisko, Z., Mulsant, B. H., & Andrews, P. W. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.09.032 · Cited by 140 · see citing works
“While this approach has had some success identifying patients that are more or less likely to respond to treatment generally, it has had little success predicting response to any particular medication or psychotherapy (Harald and Gordon, 2012; Simon and Perlis, 2010).”
Background
Dimensions in major depressive disorder and their relevance for treatment outcome
Vrieze, E., Demyttenaere, K., Bruffaerts, R., Hermans, D., Pizzagalli, D. A., Sienaert, P., Hompes, T., de Boer, P., Schmidt, M., & Claes, S. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.020 · Cited by 138 · see citing works
“In the past, several studies have used factor analytic strategies to identify subdimensions of MDD, based on clinical rating scales for depression and other symptom measures reflecting DSM-IV criteria (e.g., Carragher et al., 2009; Cassano et al., 2009; Harald and Gordon, 2012).”
The genetic basis of major depressive disorder
Jonathan Flint, C. (2023) · Molecular Psychiatry · doi:10.1038/s41380-023-01957-9 · Cited by 141 · see citing works
“…[51]), co-occurrence of diagnostic biomarkers [52 – 54], clustering subjects according to shared signatures of brain function [55 – 57] and treatment response [58 – 60], all point to this conclusion, although there is no agreement on, or conclusive demonstrations of, what the subtypes are [61, 62].”
Background
The use of latent class analysis for identifying subtypes of depression: a systematic review
Ulbricht, C. M., Chrysanthopoulou, S. A., Levin, L., & Lapane, K. L. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.03.003 · Cited by 138 · see citing works
Reduced default mode network suppression during a working memory task in remitted major depression
Bartova, L., Meyer, B. M., Diers, K., Rabl, U., Scharinger, C., Popovic, A., Pail, G., Kalcher, K., Boubela, R. N., Huemer, J., et al. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.02.025 · Cited by 135 · see citing works
“While competing sub-classifications such as typical/atypical depression, single/multiple episodeMDD as well as others (Harald and Gordon, 2012; Lamers et al., 2012; Sung et al., 2013; Thase, 2013; Rodgers et al., 2014; Wakefield and Schmitz, 2014) exist, their biological significance is still under debate and has not…”
Background
Mapping neurophysiological subtypes of major depressive disorder using normative models of the functional connectome
Sun, X., Sun, J., Lu, X., Dong, Q., Zhang, L., Wang, W., Liu, J., Ma, Q., Wang, X., Wei, D., et al. (2023) · Biological Psychiatry · doi:10.1016/j.biopsych.2023.05.021 · Cited by 129 · see citing works
Genetic heterogeneity and subtypes of major depression
Nguyen, T.-D., Harder, A., Xiong, Y., Kowalec, K., Hägg, S., Cai, N., Kuja-Halkola, R., Dalman, C., Sullivan, P. F., & Lu, Y. (2022) · Molecular Psychiatry · doi:10.1038/s41380-021-01413-6 · Cited by 129 · see citing works
“The studies to-date that have used genetic approaches to index the heterogeneity of MD subtypes are encouraging (summarized in Supplementary Table S1) but overall impeded by a paucity of large cohorts with similar ascertainment, phenotyping, and genotyping [5].”
BackgroundInfluential
Depression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions
Rantala, M. J., Luoto, S., Krams, I. A., & Karlsson, H. (2017) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2017.10.012 · Cited by 121 · see citing works
Atypical depression: current perspectives
Łojko, D., & RYBAKOWSKI, J. K. (2017) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s147317 · Cited by 118 · see citing works
“Fifteen different subtypes were described in a meta-review of Harald and Gordon, 34 with symptom-based melancholia, psychotic, and atypical subtypes, and also etiologically based and time-of-onset-based subtypes.”
Effects of Hormonal Contraceptives on Mood: A Focus on Emotion Recognition and Reactivity, Reward Processing, and Stress Response
Lewis, C. A., Kimmig, A.-C. S., Zsido, R. G., Jank, A., Derntl, B., & Sacher, J. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1095-z · Cited by 118 · see citing works
Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review
Baumeister, H., Hutter, N., & Bengel, J. (2014) · Diabetic Medicine · doi:10.1111/dme.12452 · Cited by 114 · see citing works
Biomarkers for major depressive disorder
Hacımusalar, Y., & Eşel, E. (2017) · Nöro Psikiyatri Arşivi · doi:10.5152/npa.2017.19482 · Cited by 120 · see citing works
Prospective associations of depression subtypes with cardio-metabolic risk factors in the general population
Lasserre, A. M., Strippoli, M. F., Glaus, J., Gholam‐Rezaee, M., Vandeleur, C. L., Castelao, E., Marques-Vidal, P. M., Waeber, G., Vollenweider, P., & Preisig, M. (2016) · Molecular Psychiatry · doi:10.1038/mp.2016.178 · Cited by 112 · see citing works
The potential of predictive analytics to provide clinical decision support in depression treatment planning
Kessler, R. C. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000377 · Cited by 103 · see citing works
“…(e.g., atypical or melancholic depression), or empirically derived symptom profiles in hopes of predicting heterogeneity of treat-ment effects (HTE), where HTE is defined as the existence of between-patient differences in the relative effectiveness of different types of treat-ment [24,25].”
Background
Depression subtypes and obesity in adults: A systematic review and meta‐analysis
Silva, D. A., Coutinho, E. S. F., Ferriani, L. O., & Viana, M. C. (2019) · Obesity Reviews · doi:10.1111/obr.12966 · Cited by 104 · see citing works
An epigenome-wide DNA methylation study of PTSD and depression in World Trade Center responders
Kuan, P.-F., Waszczuk, M. A., Kotov, R., Marsit, C. J., Guffanti, G., Gonzalez, A., Yang, X., Koenen, K., Bromet, E., & Luft, B. J. (2017) · Translational Psychiatry · doi:10.1038/tp.2017.130 · Cited by 103 · see citing works
Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: Time for the evidence to become practice
Baumeister, H. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.05.025 · Cited by 97 · see citing works
Self-citation
Repetitive transcranial magnetic stimulation for treatment resistant depression: Re-establishing connections
Anderson, R. J., Hoy, K. E., Daskalakis, Z. J., & Fitzgerald, P. B. (2016) · Clinical Neurophysiology · doi:10.1016/j.clinph.2016.08.015 · Cited by 96 · see citing works
“depression subtype characterised by pervasive anhedonia (Harald and Gordon, 2012), where white matter microstructural abnormal-”
Background
Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey
Brăilean, A., Curtis, J., Davis, K. A. S., Dregan, A., & Hotopf, M. H. (2019) · Psychological Medicine · doi:10.1017/s0033291719001004 · Cited by 94 · see citing works
“Although findings on differential treatment response are largely controversial (Harald and Gordon, 2012), recent evidence suggests larger treatment response to exercise in AD compared to nonAD (Rethorst et al.”
BackgroundResult
Six-year longitudinal course and outcomes of subtypes of depression
Lamers, F., Beekman, A. T. F., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H. (2015) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.114.153098 · Cited by 94 · see citing works
The differential influence of life stress on individual symptoms of depression
Fried, E. I., Nesse, R. M., Guille, C., & Sen, S. (2015) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12395 · Cited by 89 · see citing works
Role of Orexin in the Pathophysiology of Depression: Potential for Pharmacological Intervention
Nollet, M., & Leman, S. (2013) · CNS Drugs · doi:10.1007/s40263-013-0064-z · Cited by 89 · see citing works
“, melancholic or atypical depression), it is possible to observe either insomnia or hypersomnia, weight loss or weight gain, as well as an increase or decrease of the HPA axis activity [89, 90].”
Background
Stability and transitions of depressive subtypes over a 2-year follow-up
Lamers, F., Rhebergen, D., Merikangas, K. R., de Jonge, P., Beekman, A. T. F., & Penninx, B. W. J. H. (2012) · Psychological Medicine · doi:10.1017/s0033291712000141 · Cited by 88 · see citing works
“In a comprehensive review of subtyping models, Baumeister & Parker (2011) conducted a literature search and classified subtypes by symptom-based, etiology-based and time of onset-based subtypes.”
Background
Blunted Reward Processing in Remitted Melancholic Depression
Weinberg, A., & Shankman, S. A. (2016) · Clinical Psychological Science · doi:10.1177/2167702616633158 · Cited by 84 · see citing works
“In particular, although depression in general has been associated with DA-linked reward processing impairments, DA functioning may be most impaired in melancholic depression (Baumeister & Parker, 2012; Parker, 2007; Parker et al., 1995), a specifier within the MDD category.”
Background
Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions
Gili, M., Roca, M., Armengol, S., Asensio, D., García‐Campayo, J., & Parker, G. B. (2012) · PLoS ONE · doi:10.1371/journal.pone.0048200 · Cited by 84 · see citing works
The association between depression and eating styles in four European countries: The MooDFOOD prevention study
Paans, N. P. G., Bot, M., Brouwer, I. A., Visser, M., Roca, M., Kohls, E., Watkins, E. R., & Penninx, B. W. J. H. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.03.003 · Cited by 84 · see citing works
Blunted neural response to errors as a trait marker of melancholic depression
Weinberg, A., Liu, H., & Shankman, S. A. (2015) · Biological Psychology · doi:10.1016/j.biopsycho.2015.11.012 · Cited by 81 · see citing works
Structure of major depressive disorder in adolescents and adults in the US general population
Lamers, F., Burstein, M., He, J.-P., Avenevoli, S., Angst, J., & Merikangas, K. R. (2012) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.111.098079 · Cited by 82 · see citing works
Neuropsychological changes in melancholic and atypical depression: A systematic review
Bosaipo, N. B., Foss, M. P., Young, A. H., & Juruena, M. F. (2016) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.12.014 · Cited by 78 · see citing works
Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review
Baumeister, H., Haschke, A., Munzinger, M., Hutter, N., & Tully, P. J. (2015) · BioPsychoSocial Medicine · doi:10.1186/s13030-015-0039-z · Cited by 75 · see citing works
Establishing the bidirectional relationship between depression and subclinical arteriosclerosis – rationale, design, and characteristics of the BiDirect Study
Teismann, H., Wersching, H., Nagel, M., Arolt, V., Heindel, W. L., Baune, B. T., Wellmann, J., Hense, H., & Berger, K. (2014) · BMC Psychiatry · doi:10.1186/1471-244x-14-174 · Cited by 74 · see citing works
The subjective experience and phenomenology of depression following first episode psychosis: A qualitative study using photo-elicitation
Sandhu, A., Ives, J., Birchwood, M. J., & Upthegrove, R. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.01.018 · Cited by 74 · see citing works
“Indeed challenges to the established depression paradigm are also occurring within unipolar affective disorders (Harald and Gordon, 2012).”
Background
Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy
Dols, A., Bouckaert, F., Sienaert, P. A., Rhebergen, D., Vansteelandt, K., ten Kate, M., Winter, F. D., Comijs, H. C., Emsell, L., Oudega, M. L., et al. (2016) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2016.09.005 · Cited by 69 · see citing works
Discriminative Power of EEG-Based Biomarkers in Major Depressive Disorder: A Systematic Review
Greco, C., Matarazzo, O., Cordasco, G., Vinciarelli, A., Callejas, Z., & Esposito, A. A. (2021) · IEEE Access · doi:10.1109/access.2021.3103047 · Cited by 70 · see citing works
“(as pointed out by other works [156] Harald & Gordon, 2012; [5] Ulbricht et al.”
BackgroundMethod
White matter abnormalities in major depressive disorder with melancholic and atypical features: A diffusion tensor imaging study
Ota, M., Noda, T., Sato, N., Hattori, K., Hori, H., Sasayama, D., Teraishi, T., Nagashima, A., Obu, S., Higuchi, T., et al. (2014) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.12255 · Cited by 68 · see citing works
“There are 227 possible symptom constellations of a DSM-IV-defined major depression episode, and a previous meta-analysis demonstrated that the MDD subtypes have never been shown to be absolutely distinct from one other, with substantial overlaps across symptoms, causes, biological underpinnings and time of onset.(42)…”
Result
MAJOR DEPRESSIVE DISORDER SUBTYPES TO PREDICT LONG-TERM COURSE
van Loo, H. M., Cai, T., Gruber, M. J., Li, J., de Jonge, P., Petukhova, M. V., Rose, S., Sampson, N. A., Schoevers, R. A., Wardenaar, K. J., et al. (2014) · Depression and Anxiety · doi:10.1002/da.22233 · Cited by 68 · see citing works
The 341 737 ways of qualifying for the melancholic specifier
Fried, E. I., Coomans, F., & Lorenzo‐Luaces, L. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(20)30169-3 · Cited by 68 · see citing works
Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System
Sussman, M., O’sullivan, A. K., Shah, A., Olfson, M., & Menzin, J. (2019) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2019.25.7.823 · Cited by 65 · see citing works
Psychological and pharmacological interventions for depression in patients with coronary artery disease
Tully, P. J., Ang, S. Y., Lee, E. J., Bendig, E., Bauereiß, N., Bengel, J., & Baumeister, H. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008012.pub4 · Cited by 66 · see citing works
Associations between depression subtypes, depression severity and diet quality: cross-sectional findings from the BiDirect Study
Rahe, C., Baune, B. T., Unrath, M., Arolt, V., Wellmann, J., Wersching, H., & Berger, K. (2015) · BMC Psychiatry · doi:10.1186/s12888-015-0426-9 · Cited by 65 · see citing works
“This approach has been increasingly criticized, as depression is a phenotypically and biologically heterogeneous illness [21-23].”
Background
The identification of symptom-based subtypes of depression: A nationally representative cohort study
ten Have, M., Lamers, F., Wardenaar, K. J., Beekman, A. T. F., de Jonge, P., van Dorsselaer, S., Tuithof, M., Kleinjan, M., & de Graaf, R. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.10.040 · Cited by 64 · see citing works
“…Study of Depression and Anxiety (NESDA) CIDI 2.1: D We focused on symptom-based depressive subtypes and omitted other depressive subtyping models, such as time of onsetbased subtypes containing early- and late-onset depression and seasonal affective disorder (Baumeister and Parker, 2012).”
BackgroundMethodInfluential
Changes of grey matter volume in first-episode drug-naive adult major depressive disorder patients with different age-onset
Shen, Z., Cheng, Y., Yang, S., Dai, N., Ye, J., Liu, X., Lü, J., Li, N., Liu, F., Lü, Y., et al. (2016) · NeuroImage Clinical · doi:10.1016/j.nicl.2016.08.016 · Cited by 64 · see citing works
“, 2014), one meta-review also indicating the different ageonset depression might be different subtypes of depression (Harald and Gordon, 2012).”
Background
Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data
Lorenzo‐Luaces, L., Peipert, A., Jesús-Romero, R. D., Rutter, L. A., & Rodríguez‐Quintana, N. (2020) · International Journal of Cognitive Therapy · doi:10.1007/s41811-020-00094-3 · Cited by 62 · see citing works
Age-dependent symptomatology of depression in hospitalized patients and its implications for DSM-5
Wilkowska-Chmielewska, J., Szelenberger, W., & Wojnar, M. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.12.012 · Cited by 60 · see citing works
Symptom-based subtypes of depression and their psychosocial correlates: A person-centered approach focusing on the influence of sex
Rodgers, S., Holtforth, M. G., Müller, M., Hengartner, M. P., Wulf Rössler, A., & Ajdacic‐Gross, V. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.11.021 · Cited by 58 · see citing works
Acylcarnitine metabolomic profiles inform clinically-defined major depressive phenotypes
Ahmed, A. T., MahmoudianDehkordi, S., Bhattacharyya, S., Arnold, M., Liu, D., Neavin, D. R., Moseley, M. A., Thompson, J. W., Williams, L. S. J., Louie, G., et al. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.122 · Cited by 59 · see citing works
Geschlechtsspezifische Aspekte bei depressiven Erkrankungen
Karger, A. (2014) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-014-2019-z · Cited by 43 · see citing works
Racial and ethnic differences in depressive subtypes and access to mental health care in the United States
Lee, S. Y., Xue, Q., Spira, A. P., & Lee, H. B. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.037 · Cited by 55 · see citing works
Epidemiology of pharmaceutically treated depression and treatment resistant depression in Taiwan
Fife, D., Feng, Y., Wang, M. Y.-H., Chang, C., Liu, C.-Y., Juang, H.-T., Furnback, W. E., Singh, J. B., & Wang, B. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.03.006 · Cited by 55 · see citing works
“Such studies have typically used changes of AD medication regimens (augmentation, dose titration, switching, or addition of a new medication) as evidence of a regimen's failure (Gibson, 2012; Greenberg, 2004; Harald and Gordon, 2012).”
Early onset of depression and treatment outcome in patients with major depressive disorder
Herzog, D. P., Wagner, S., Engelmann, J., Treccani, G., Dreimüller, N., Müller, M. B., Tadić, A., Murck, H., & Lieb, K. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.05.048 · Cited by 52 · see citing works
Definition of treatment-resistant depression – Asia Pacific perspectives
Ng, C. H., Kato, T., Han, C., Wang, G., Trivedi, M. H., Ramesh, V., Shao, D., Gala, S. G., Narayanan, S., Tan, W., et al. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.038 · Cited by 55 · see citing works
The Australian Genetics of Depression Study: New Risk Loci and Dissecting Heterogeneity Between Subtypes
Mitchell, B. L., Campos, A. I., Whiteman, D. C., Olsen, C. M., Gordon, S. D., Walker, A. J., Dean, O. M., Berk, M., Hickie, I. B., Medland, S. E., et al. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.10.021 · Cited by 47 · see citing works
Are depression and anxiety determinants or indicators of quality of life in breast cancer patients?
Hutter, N., Vogel, B. A., Alexander, T., Baumeister, H., Helmes, A. W., & Bengel, J. (2012) · Psychology Health & Medicine · doi:10.1080/13548506.2012.736624 · Cited by 51 · see citing works
“Thereby, cytokine-induced depression might differ from other subtypes of depression (Baumeister & Parker, 2012) and consequently might be differently associated with QoL.”
Background
Interleukin, tumor necrosis factor-α and C-reactive protein profiles in melancholic and non-melancholic depression: A systematic review
Yang, C., Tiemessen, K. M., Bosker, F. J., Wardenaar, K. J., Lie, J., & Schoevers, R. A. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.05.008 · Cited by 51 · see citing works
Does early-onset chronic or recurrent major depression impact outcomes with antidepressant medications? A CO-MED Trial Report
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Oral contraceptives positively affect mood in healthy PMS-free women: A longitudinal study
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“The AAO-MD phenotype is primarily used to dissect MD heterogeneity [5], i.”
Method
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“Tohandle the heterogeneity, psychiatrists exclusively divided patients with depression into categories according to clinical manifestations (Harald & Gordon, 2012; Lynch et al., 2020).”
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“(2) This study was a non-multicenter study; (3) the ability to detect biomarkers reflecting inflammatory and immune responses was insufficient, which could not fully reflect the pathophysiological process of depression; (4) important psychosocial stress situations related to depressive events and pre-admission treatme…”
BackgroundMethodInfluential
Big Five personality characteristics are associated with depression subtypes and symptom dimensions of depression in older adults
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“…depression appears to be a heterogeneous disorder that makes it important to further specify its diagnostic and classification criteria (e.g. Baumeister and Gordon, 2012; Gili et al., 2012; Lamers et al., 2010; Rhebergen, 2012) and to examine personality factors in relation to different…”
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“Unfortunately, more homogeneous clinical subtypes have been shown to be weakly associated with etiology, the course of illness, and treatment response (Baumeister and Parker, 2012).”
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Understanding Activity Limitations in Depression
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“There is a longstanding debate about possible subtypes in MDD, which focused on the clinical heterogeneity in symptomatology and course of the disease (Fried and Nesse, 2014; Harald and Gordon, 2012; Ten Have et al., 2016).”
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Seasonality of mood and affect in a large general population sample
Winthorst, W. H., Bos, E. H., Roest, A. M., & de Jonge, P. (2020) · PLoS ONE · doi:10.1371/journal.pone.0239033 · Cited by 36 · see citing works
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“Likewise, hallucinations vary in etiology depending on the particular sensory modality involved, whereas depression may involve a number of qualitatively distinct subtypes [37].”
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“…atypical depression (e.g. increased eating, sleeping, etc.), dysthymia (e.g. persistent low-grade depression), and seasonal depression vary in their etiology and symptoms (Harald and Gordon, 2012), however, it is unclear if these conditions can be differentiated according to neurobiology.”
Background

Data-driven biological subtypes of depression: Systematic review of biological approaches to depression subtyping
Beijers, L., Wardenaar, K. J., van Loo, H. M., & Schoevers, R. A. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0385-5 · Cited by 240 · see citing works
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Authors: Harald, B., & Gordon, P.
Affiliations: Black Dog Institute (AU)
Venue: Journal of Affective Disorders
Publisher: Elsevier BV
Published: 2012-07
Volume: 139
Issue: 2
Pages: 126-140
ISSN: 0165-0327 (ISSN-L)
DOI: 10.1016/j.jad.2011.07.015
OpenAlex: W2059553907
Cited by: 328
References: 213
Citations by year: 2026: 11 · 2025: 26 · 2024: 17 · 2023: 25 · 2022: 27 · 2021: 19 · 2020: 20 · 2019: 24 · 2018: 16 · 2017: 32 · 2016: 26 · 2015: 27 · 2014: 21 · 2013: 21 · 2012: 14
FWCI: 2.30
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Affective Disorders (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords: depression subtypes, major depressive disorder, melancholia, psychotic depression, atypical depression, anxious depression, perinatal depression, organic depression, drug-induced depression, seasonal affective disorder, early-onset depression, late-onset depression, depression in women, treatment-resistant depression, etiology of depression, differential treatment
MeSH terms: Major Depressive Disorder, Female, Humans, Male, United States

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