What Is Atypical Depression?

Atypical depression is considered a type of depression with a “specifier.” Specifiers are additional symptoms or traits that are included in an umbrella diagnosis under disorders such as clinical depression—also called major depressive disorder. Specifiers help to further clarify the specifics of a diagnosis and may suggest certain therapeutic approaches.

Therefore, atypical depression is a specific type of presentation of major depressive disorder. It can also be associated with other mood disorders such as bipolar disorder (a condition involving extreme mood disturbances) or dysthymia, now known as persistent depressive disorder (a chronic, mild to severe depressed mood). So, what is the difference between an atypical depression and one that is not? What causes atypical depression and what type of treatment works best? 

What Is Atypical Depression? 

Clinical depression with atypical features (or atypical depression) is a term that defines people’s symptoms when they have symptoms that are not "typical" of a major depressive episode. Usually, depression causes a person to have difficulty sleeping and experience a loss of appetite. But not in those with atypical depression. Atypical features of clinical depression is a DSM specifier used for people who display unusual depressive symptoms such as:

• Mood reactivity (a person's mood brightens in response to positive events)
• Significant weight gain
• Increase in appetite
• Hypersomnia (sleeping excessively)
• Leaden paralysis (a heavy, leaden feeling in arms or legs)
• A behavioral pattern of being highly sensitive to rejection in personal relationships

Symptoms

The DSM-V is a diagnostic manual that sets the standards for what, exactly, constitutes a specific mental health diagnosis. According to the DSM-V, atypical depression is characterized by mood reactivity (mood brightening in response to positive events), along with two or more of the following symptoms:

• Overeating
• Oversleeping
• Leaden paralysis (a feeling of extreme heaviness in the legs)
• Interpersonal rejection sensitivity (having a pattern of a long-standing fear of being rejected, which interferes with the ability to form new social connections)

There may also be other "typical" depressive symptoms present, including:

• Severe, ongoing sadness, or feeling hopeless
• Irritability or anxiety
• Loss of interest in hobbies and/or activities that were enjoyed in the past
• Trouble concentrating
• Memory problems
• Trouble making decisions
• Low energy level
• Fatigue
• Suicidal thoughts or obsession with death or dying

Diagnosis

A diagnosis of atypical depression may start with getting a physical exam, undergoing some lab tests (such as a test for thyroid dysfunction), and other diagnostic measures to ensure that your symptoms are not stemming from a physical illness. After which, you may be referred to a mental health professional. They will perform a thorough diagnostic evaluation, which usually includes:

A psychiatric evaluation: This includes many in-depth questions about your thoughts, feelings, and patterns of behavior; your answers will be compared to the criteria in the DSM-V that spells out which symptoms indicate a person has atypical depression.

A family history: This is to find out if you have any family members with atypical depression, particularly when it is linked with bipolar disorder. Bipolar disorder (sometimes called manic depressive disorder) in the family has been linked with atypical depression.

Atypical Depression and Mood Disorders

In addition to atypical depression being a specifier for major depressive disorder, it may also be a specifier for other mood disorders. The DSM-5 criteria for atypical depression indicates that atypical features may be a specifier for major depressive episodes when:

• A major depressive episode is the most recent mood episode in bipolar (note bipolar disorder may involve extreme mood swings, including an extremely excitable, expansive or irritable mood called mania, often alternating with periods of depressive moods).
• Atypical features can be a specifier for persistent depressive disorder (dysthymia).

Incidence of Atypical Depression

According to Harvard Health, atypical features occur in approximately 20% of depressive episodes in people with mood disorders. The Harvard Health report goes on to explain that atypical features are two to three times more common in women than in men and that in general, depression is twice as common in women than it is in men. Depression with atypical features:

• Starts at an earlier age (some experts believe that atypical depression usually begins before age 20).
• Is chronic (long-term) and lasts longer than depression without atypical features
• Is more likely to occur in people with bipolar disorder and seasonal affective disorder (depression linked with specific seasons of the year)

Causes

The exact cause of atypical depression is unknown, but it has been linked with some factors. Atypical depression is known to:

• Begin earlier than other types of depression
• Have more of a chronic (long-term) course
• Have abnormal or impaired neurotransmitters (brain chemicals that work to transmit signals from one nerve cell to another)
• Be more likely when other family members have atypical depression (particularly when it is linked with bipolar disorder)

Risk Factors for Atypical Depression

Factors that may make a person more prone to having atypical depression include:

• Having a history of bipolar disorder
• Familial link to people with atypical depression, bipolar disorder or alcoholism
• Substance abuse (including alcohol or drug abuse)
• Trauma (particularly during childhood)
• Environmental stressors (such as living with a person who is abusive)
• Stressful events in life (such as the death of a loved one)

Treatment

Interestingly, atypical depression was first identified as a diagnosis that was different from clinical depression because studies discovered that these individuals responded better to a specific type of antidepressant, called MAO inhibitors (compared to other types of antidepressants).

Medication

Antidepressants are medications that help regulate brain chemistry. Atypical depression is said to respond very well to a category of antidepressant medications called monoamine oxidase inhibitors (MAOIs), and other antidepressants (such as serotonin reuptake inhibitors or SSRIs) may also be effective.

Side Effects of Medication

Many drugs that treat mental health disorders have significant side effects. The common side effects of MAOI’s may include:

• Nausea
• Dry mouth
• Loss of appetite
• Diarrhea or constipation
• Headache
• Insomnia
• Drowsiness
• Lightheadedness
• Low blood pressure
• A reduced sex drive
• Muscle spasms
• Weight gain
• Trouble urinating
• Paresthesia (a tingling sensation in the skin)

The good news about side effects from antidepressants is that most often improve after you have taken the medication for a while. It’s important to discuss any side effects with the prescribing healthcare provider. Your healthcare provider may change your prescription if the side effects don’t subside in a timely manner.

Psychotherapy

Psychotherapy, also referred to as “talk therapy,” involves meeting with a mental health professional (such as a counselor or a therapist). Psychotherapy has been found to be highly effective in those with atypical depression.

Coping

Treatment for atypical depression usually involves helping a person with the condition to learn better ways of coping, these may including:

• How to notice unhealthy thoughts or behaviors and how to make changes once these patterns are identified.
• How to cope with various problems by implementing problem-solving processes?
• How to deal with troubling relationships and experiences
• How to set (and attain) realistic goals?
• How to lessen depressive symptoms
• How to implement healthy lifestyle changes (such as quitting drugs or alcohol)

A Word From Verywell

With an accurate diagnosis and proper treatment, most people can learn to live with atypical depression, and many get relief from their symptoms. If you have symptoms of atypical depression, be sure to talk to your primary healthcare provider; don’t be afraid to ask for a referral to a mental health professional to get a thorough evaluation/diagnostic assessment. This is the first step to being proactive about your mental health.