A version of depression, appearing in DSM-IV TR, and known better by practicing psychiatrists for decades, depression with "atypical features" refers to "fatigue superimposed on a history of somatic anxiety and phobias, together with reverse vegetative signs (mood worse in the morning, insomnia, tendency to oversleep and overeat), so that weight gain occurs rather than weight loss." Patients with atypical depression respond to external positive and negative events,
SSRIs are somewhat effective, but MAOIs appear to have higher specificity for these patients (of course, watch the tyramine and other pressor amines). In the case of atypical depression, psychostimulants have been of benefit, including dextroamphetamine and methylphenidate. We use Provigil sometimes in these patients, depending on medical issues, labs, and other presenting symptoms and history...usually with good results. I won't talk about the geriatric atypical depression patient with Cotard's syndrome where we tried Provigil and other meds, accidentally induced some cholinergic effects with a missed history of narrow angle glaucoma. It all worked out in the end though. Read up on it, kids....
To answer your second question. It completely depends, but yes, I would consider it and lots of other things depending on the history, labs, PMhx, etc.
