Ignoring atypical symptoms of depression in common scales

doi:10.5498/wjp.v15.i11.107832

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Nov 19, 2025 (publication date) through Mar 28, 2026

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Psychiatry. Nov 19, 2025; 15(11): 107832
Published online Nov 19, 2025. doi: 10.5498/wjp.v15.i11.107832

Ignoring atypical symptoms of depression in common scales

Evgeny D Kasyanov, Yana V Yakovleva, Egor S Shchepkin, Galina E Mazo

Evgeny D Kasyanov, Yana V Yakovleva, Egor S Shchepkin, Department of Social Neuropsychiatry, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg 190000, Sankt-Peterburg, Russia

Galina E Mazo, Deputy Director for Innovative Scientific and Innovative Development, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Saint Petersburg 190000, Sankt-Peterburg, Russia

Author contributions: Kasyanov ED designed the review framework and identified the research focus and analyzed the data and drafted the manuscript; Yakovleva YV and Shchepkin ES conducted the literature search and selected relevant studies; Kasyanov ED and Mazo GE conducted a data synthesis; Mazo GE provided critical revisions and final approval of the manuscript; and all the authors have read and approved the final manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Evgeny D Kasyanov, MD, PhD, Department of Social Neuropsychiatry, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhtereva St., 3, 192019, Saint Petersburg 19000, Sankt-Peterburg, Russia. i@kasyan.ru

Received: April 1, 2025
Revised: May 28, 2025
Accepted: September 10, 2025
Published online: November 19, 2025
Processing time: 220 Days and 8.1 Hours

Abstract

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.

Keywords: Atypical depression; Bipolar disorder; Mood reactivity; Depression assessment scales; Inventory of Depressive Symptomatology

Core Tip: Common depression rating scales do not fully address atypical symptoms (e.g., mood reactivity, hypersomnia, hyperphagia, leaden paralysis, and interpersonal sensitivity), potentially underestimating atypical depression severity. Only three scales cover all five atypical features, with the Inventory of Depressive Symptomatology offering the most comprehensive assessment. Incorporating atypical symptoms is crucial for accurate severity evaluation and advancing both clinical and basic research on depression.