What Is Atypical Depression?

Medically reviewed by Melissa Guarnaccia
Updated March 8, 2024by BetterHelp Editorial Team
Content warning: Please be advised, the below article might mention substance use-related topics that could be triggering to the reader. If you or someone you love is struggling with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357). Support is available 24/7. Please see our Get Help Now page for more immediate resources.

Depression isn't 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 disorders (winter or summer depression), postpartum depression, situational depression, and atypical depression. 

All these disorders are considered mood disorders. 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?

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Scientists and psychiatrists have often disagreed on the symptoms, course, and treatment of atypical depression. The American Psychiatric Association DSM-5 (a diagnostic and statistical manual) lists atypical depression as a "specifier" of major depressive disorder and persistent depressive disorder. Atypical depression is depression that has specific features and diagnostic criteria that are not usually associated with depression.

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 patients with depression are thought to experience atypical depression. Atypical depression is also two to three times more common in women. 

What's so atypical about atypical depression?

Two things set atypical depression apart from general depressive disorders and other mental health disorders: 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. Common depression symptoms including loss of appetite, trouble sleeping, and feeling sad much of the time. This is not the case with atypical depression. 

Some symptoms of atypical depression are like those of other forms of depression. These include:

  • Loss of enjoyment
  • Sadness
  • 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
  • A generally depressed mood
  • Substance abuse

Atypical depression is characterized by other symptoms, though. People with atypical depression have some or all the following symptoms, too.

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Mood reactivity

Mood reactivity means that you react to positive events with positivity, even though you are depressed. While a person with 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 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. Rejection can trigger a major depressive episode.

Leaden paralysis

Leaden paralysis refers to a feeling of heaviness in your arms or 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.

Excessive sleeping

People with atypical depression tend to sleep more than usual. Because of experiencing a depressed mood, they may oversleep in the morning and take long naps throughout the day. If you sleep 10 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

Depression and weight gain are often related, since symptoms may cause a person to turn to food as a coping mechanism. If the foods they choose are high in fat and sugar, as many comfort foods are, this may even contribute to a worsening of symptoms.

Premenstrual symptoms

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.

Atypical depression’s relationship with other mental health conditions

Often, people with atypical depression also have other mental conditions. Dysthymic disorder, which is a chronic form of depression, can be a serious illness. 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

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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.

Bipolar disorder

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. At this point, all that can be said is that people with bipolar disorder have atypical symptoms during the depressed phase slightly more often than people with unipolar depression do. Bipolar disorder can be successfully treated with medications and therapy, yet some people develop substance use falsely believing street drugs will make them feel better.

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. As a result of this, weight gain is a common symptom of seasonal affective disorder. However, they aren't any more likely to have a sensitivity to rejection.

Personality disorders

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 control.

Neuropsychiatric disease

This type of mental disorder deals with neurology and psychiatry. In most cases, this type of disorder begins with some type of brain malfunction. These types of conditions include addictions, degenerative diseases, eating disorders, neurotic disorders, sleep disorders, and psychosis.

Melancholic depression

Melancholic depression is considered a major depressive disorder. The American Psychiatric Association recognizes melancholic depression as a specifier for major depressive disorder rather than a separate mental illness.

What causes atypical depression?

It isn't yet clear whether the causes of atypical depression are mostly the same as the causes of other forms of depression as many of the risk factors are the same. Still, there may be some differences in the way atypical depression occurs.

Biological causes

Atypical depression often starts during the teenage years, though 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, and the chemical balance in the brain.

Atypical depression may have a genetic component, although it hasn't been identified precisely yet. Drug or alcohol misuse can create brain changes, which 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 eating disorders or overeating and oversleeping.

Family history

If you have one or more blood relatives who have had depression, alcoholism, bipolar depression, or some other type of mental illness you are at higher risk of depression, including depression with atypical features.

Life events

Life events can have a major impact on your mental health. If you experienced 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, weight gain, moving, or changing jobs, can increase your chances of depression, too.

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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.

Medications

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You don’t have to experience depression alone

At one time, MAOIs (monoamine oxidase inhibitors) 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 (monoamine oxidase) are used as well. 

Therapy

With or without medications, talk therapy is a front-line treatment for atypical depression. By talking about your concerns and learning tips and techniques for dealing with atypical depression symptoms, you can improve your condition dramatically. Studies have found that cognitive-behavioral therapy or CBT is particularly effective as a treatment option for atypical depression, especially when combined with other factors such as appropriate medication. Additionally, recent studies have found that online CBT is just as effective as its traditional counterpart for the treatment of a range of depressive conditions. 

For people with personality disorders, dialectical behavior therapy can also be helpful. This method includes individual psychotherapy and group skills training to learn mindfulness, distress tolerance, emotional control, 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. As you learn how to understand and manage 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.

Takeaway

Atypical depression is similar to other forms of depression, but it also has some unique symptoms. It is also sometimes experienced alongside other mental health disorders, such as anxiety, bipolar disorder, substance use disorder, among others. One of the most important treatments for atypical depression is talk therapy. Online therapy with BetterHelp is here to help.
Depression is treatable, and you're not alone
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