What Is Atypical Depression?
Updated December 14, 2018
Reviewer Tanya Harell
Depression isn't always the same for everyone. In fact, scientists have identified several different subtypes of depression, including major depression, dysthymia (mild, persistent depression), bipolar depression, seasonal affective disorder (winter depression), postpartum depression, situational depression, and atypical depression. This last one, atypical depression, has much in common with other forms of depression, but it also has some unique features.
What Is Atypical Depression?
The diagnosis of atypical depression has been in dispute for many years. Scientists and psychiatrists have often disagreed on what the symptoms, course, and treatment of atypical depression might be. Currently, the DSM-5 lists atypical depression as a "specifier" to major depressive disorder and persistent depressive disorder. In other words, the term is used to specify which types of symptoms a person with those disorders has during one particular incident of depression.
Atypical depression is depression with specific features that are not usually associated with depression. Its symptoms, listed below define it.
How Common Is Atypical Depression?
About 16.2 million U.S. adults have had at least one episode of major depressive disorder. Although it's called atypical, depression with atypical features is quite common. Estimates of the prevalence of atypical depression vary greatly from study to study. Somewhere between 15% and 40% of depressed patients are thought to suffer from atypical depression. Atypical depression is two to three times more common in women than in men.
What's So Atypical About Atypical Depression?
Two things set atypical depression apart: its symptoms and the treatments that tend to be most effective. The symptoms of atypical depression run counter to what most people think of as depression. In typical depression, people tend to lose their appetite, have trouble sleeping, and stay sad most of the time. Not so in atypical depression. As for treatment, different medications tend to work better for people with atypical depression.
Some symptoms of atypical depression are like those of other forms of depression. These include:
- Loss of Enjoyment
- Restless or Rundown Feeling
- Fatigue or Loss of Energy
- Feelings of Hopelessness, Worthlessness, or Guilt
- Trouble Concentrating and Making Decisions
- Thoughts of Death or Suicide
Atypical depression is characterized by other symptoms, though. People with atypical depression have some or all the following symptoms, too.
Mood reactivity means that you react to positive events with positivity, even though you are depressed. While a person with a typical depression continues to feel bad no matter what happens, a person with atypical depression can feel happy when something good happens.
Sensitivity To Rejection
People with atypical depression tend to feel strongly sensitive to the rejection of others. When you have atypical depression, you notice every possible rejection and tend to expect rejection in many different circumstances. You may feel rejected by your lover or friend at the slightest hint that you don't have their 100% approval and acceptance.
Leaden paralysis refers to a feeling of heaviness in your arms and legs. If you feel that sense of heaviness for at least one hour a day or more, it can be a sign of atypical depression.
People with atypical depression tend to sleep more than usual. They may oversleep in the morning and take long naps throughout the day. If you sleep ten or more hours a day or two hours more than usual, it may be a sign you have atypical depression.
Increased Appetite And Weight Gain
Atypical depression usually comes with increased appetite. If the atypical depression goes on long enough, the result is usually a weight gain of at least 5 pounds.
Women with PMS and atypical depression not only have increased appetites, but they also tend to prefer carbohydrates and sweets like chocolates during the premenstrual phase. This may be their body's way of self-medicating to relieve the symptoms of PMS and depression temporarily.
Relationship With Other Mental Health Conditions
Often, people with atypical depression also have other mental conditions. These conditions influence the way people are affected by atypical depression. Their other conditions may also contribute to the depression, making it harder for them to overcome it and move on to better mental health.
Anxiety disorders are often associated with atypical depression. Thirty percent of people with social phobia have atypical depression. Thirty percent of people with obsessive-compulsive disorder have it. Sixty-four percent of people with panic disorder also have atypical depression.
Clinicians often notice that people with bipolar disorder are more prone to having atypical depression, but little scientific research has been done to establish the exact prevalence. All that can be said at this point is that people with bipolar disorder have atypical symptoms during the depressed phase slightly more often than people with unipolar depression do.
Seasonal Affective Disorder
People with seasonal affective disorder experience two of the main atypical depression symptoms more often than people with non-seasonal depression. They are more likely to overeat and oversleep. However, they aren't any more likely to have a sensitivity to rejection.
Personality disorders that create emotional instability are often associated with atypical depression. These include borderline and avoidant personality disorders. This may be partly due to the problems people with these disorders have with interpersonal relationships and emotional regulation.
What Causes Atypical Depression?
It isn't yet clear whether the causes of atypical depression are mostly the same as the causes for typical depression. Still, there may be some differences in the way atypical depression happens.
Atypical depression often starts during the teenage years. It can become a chronic, even life-long struggle. Differences in the brain may be the cause. These differences can include the functions of nerve receptors and the nerves themselves as well as the chemical balance in the brain.
Atypical depression may have a genetic component, although it hasn't been identified precisely yet. Drug or alcohol abuse can create brain changes as well, that can increase your risk of atypical and other types of depression.
For atypical depression specifically, the hypothalamus may have a significant impact. As the hypothalamus responds to stress, the pituitary gland secretes adrenocorticotropic hormone (ACTH), which prompts the adrenal glands to release cortisol. If you have certain conditions, such as Cushing's disease, the pituitary is damaged, so it doesn't stop sending ACTH. The same process happens with seasonal depression, postpartum depression, and chronic fatigue syndrome. The result is overeating and oversleeping.
If you have one or more blood relatives who have had depression, alcoholism, or bipolar depression, you are at higher risk of depression, including depression with atypical features.
Life events can have a major impact on your mental health. If you suffered abuse or trauma as a child, depression is more likely. Abuse of any kind can cause mental conditions like atypical depression and others. The death of someone close to you can bring on atypical depression. Other stressful life events, including ending a romantic relationship, moving, or changing jobs can increase your chances of depression, too.
Treatments For Atypical Depression
Fortunately, depression is a highly treatable condition. Atypical depression responds to the same treatments as typical depression does. Talking to a psychiatrist is important if your depression is long-lasting or impairs your daily functioning, because you may need medications to recover. A psychotherapist can help you regardless of whether you need medications or not.
At one time MAOIs were considered the preferred treatment for atypical depression. However, MAOIs come with difficult side effects. They can cause drowsiness or insomnia. They can also create a life-threatening rise in blood pressure if you eat certain foods, such as pickles, cheese, or red wine.
Now, doctors usually prescribe SSRI medications for atypical depression. Sometimes, tricyclic antidepressants are used as well. Some of the most common medications used for atypical depression include:
With or without medications, therapy is a front-line treatment for atypical depression. By talking about your problems and learning tips and techniques for dealing with atypical depression symptoms, you can improve your condition dramatically.
Cognitive behavioral therapy can help you choose different thoughts that provide a more helpful basis for positive feelings and behaviors. Your counselor can guide you in identifying the thoughts that are causing you distress, evaluating those thoughts, and deciding about what to do about the thoughts. Once you replace unhelpful thoughts with helpful ones, you are on the path to better mental health.
For people with personality disorders, dialectical behavior therapy can be the most helpful. This method includes individual psychotherapy as well as group skills training to learn mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness.
You can talk to a licensed counselor at BetterHelp.com for individual, online therapy on your schedule. Your therapist is there to support you through this difficult time. As you learn how to understand and deal with your depression more effectively, you can get back to living a more active, fulfilling life. Through appropriate mental health care, you can enjoy life more consistently and completely.