Ignoring atypical symptoms of depression in common scales

BACKGROUND Atypical depression is an important indicator of a high risk of bipolar disorder and a genetic predisposition to immunometabolic traits. AIM To analyze common depression assessment scales for their inclusion of items related to atypical symptoms such as mood reactivity, hypersomnia, increased appetite (or weight gain), leaden paralysis, and interpersonal sensitivity. METHODS A search for English-language articles was conducted without time restrictions in the MEDLINE and Russian Science Citation Index databases using the following keywords: “depression” OR “bipolar depression” AND “scales” OR “questionnaires”. The analytical method used in this review involved a descriptive analysis of the included studies. RESULTS After reviewing studies on the validation of depression assessment scales, we found that only a small number include items addressing both increases and decreases in appetite or weight, as well as variations in sleep duration. Moreover, only a few studies have evaluated mood reactivity, leaden paralysis, and interpersonal sensitivity. The most well-developed scale that considers all aspects of atypical and non-atypical depressions is the Inventory of Depressive Symptomatology. CONCLUSION Ignoring atypical symptoms in common scales can lead to underestimation of depression severity and inaccuracies in evaluating therapy effectiveness in clinical trials, as well as hinder fundamental research aimed at finding biomarkers.