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The paper reviews Russian and foreign literature on atypical depression (AtD). It sets forth the historical aspects of identifying AtD among other depressive disorders: the authors have traced the path from depression with individual atypical manifestations to a syndrome with a clearly defined pattern and inclusion criteria in the international DSM-4 and DSM-5 classifications. The paper gives epidemiological indicators and shows their diversity due to various approaches to the determination and clinical assessment of AtD. It analyzes the results of studying AtD in the presence of various affective disorders, such as recurrent depressive disorder, bipolar affective disorder, and psychogenic depression, and notes their heterogeneity in both symptoms and genesis. The authors present approaches to treating AtD and the results of investigating drug (antidepressant) and non-drug (cognitive-behavioral psychotherapy, increased physical activity therapy) treatments.

The paper systematizes the history of studying the neurochemical activity of mianserin and mirtazapine. The concept of the development of the antidepressant effect of these drugs, by stimulating the release of norepinephrine into the synaptic cleft, is shown to have gained unanimously acceptance. The data on manifestation of their thymoleptic effect due to stimulation of the release of serotonin into the synaptic cleft have been disputed. Other neurochemical theories of the development of the antidepressant activity of mianserin and mirtazapine have been unproven or rejected. The history of identifying the position of mianserin and mirtazapine in the classification of antidepressants has been generalized. The paper shows the ambiguity of approaches to this issue. As turned out, the legality of using the term «noradrenalinergic and specific serotonergic antidepressant» has been criticized. Analysis of historical facts has identified that it is rational to assign mianserin and mirtazapine to one neurochemical group and its designation by the term «norepinephrine and (presumably) serotonin release stimulators – α 2 -adrenergic receptor and serotonin 5-HT2 receptor blockers».

Depression is the most common non-motor manifestation of Parkinson's disease (PD), which significantly affects the rate of disease progression and increases the risk of motor complications and dementia. The paper considers the etiology and pathogenesis, cause-and-effect factors of depression in PD, and features of its diagnosis and treatment. Attention is paid to the algorithm for a physician's actions in the detection of depressive disorder in a patient with PD, to the choice of an antidepressant, and to the promising areas of therapy.

The paper discusses whether antidepressant treatment is rational in schizophrenics. It analyzes the results from trials evaluating the efficiency of the therapy in patients with depressive, negative, or obsessive-phobic symptoms. The validity of results of these trials is assessed. The results of demonstrative trials of the efficiency of therapy with different representatives of antidepressants (selective serotonin reuptake inhibitors) in the above patient groups are given separately and compared with the data obtained in observational studies. Emphasis is placed on the criticism of shortages of procedures and results of demonstrative trials conducted in foreign countries. Prospects for further trials evaluating the efficiency of antidepressant therapy for schizophrenia are depicted.

The paper presents current psychopharmacological approaches to therapy for depressions. It discusses the efficacy of depressants with a monoaminergic mechanism of action. Whether combination therapy with antidepressants and drugs from other pharmacological groups may be used is considered. Separate attention is paid to the agents whose antidepressant effect is unrelated to their action on the monoaminergic system.