An Overview of Depression with Atypical Features

What is it?
Common depression leads individuals to feel sad and not enjoy everyday life. Depression with atypical features1 or more commonly, atypical depression, refers to a depressive state where individuals experience improved mood when encountering pleasurable events. This type of major depression, or dysthymia1, is atypical of melancholic depression, where mood improvements from positive situations do not typically manifest in affected individuals1. The name is a misnomer, though. It is not uncommon or unusual2; in fact, atypical depression is over two times more common in women than men and is more chronic with an average earlier onset than melancholic depression1. An increased risk of suicide and anxiety disorders is present with atypical depression. Individuals experiencing bipolar I, bipolar II, cyclothymia, and seasonal affective disorder are more likely to also experience atypical depression4. Some researchers believe that atypical depression is due to key brain differences, inclusive of abnormal chemical neurotransmitters carrying signals to the brain and body, and heredity.

What are the Symptoms?
The DSM-IV-TR1 classifies atypical depression as a subtype of Major Depressive Disorder.
It presents itself with the following characteristics1,2:

Mood improvement due to positive events or good news
At least two of the following:
Increased appetite or significant weight gain
Hypersomnia (usually more than 10 hours a day)
Leaden paralysis (i.e., heavy limb sensation, lasting more than an hour per day)
Interpersonal rejection sensitivity, leading to social or occupational impairment
Criteria are not present in Major Depressive Disorder with Melancholic or Catatonic Features during depressive episodes
Less common features of atypical depression include2:

Insomnia
Eating disorders (e.g., bulimia, bingeing, food restrictions)
Poor body image
Headaches
How is it Diagnosed?
First, your doctor will likely conduct a physical exam and ask a number of questions about your health to determine if depression symptoms are resultant from a physical health condition. Lab tests may be performed to do a blood analysis and/or thyroid test to determine proper functioning. Psychological evaluations are given to check for signs of depression and to gain insight into your symptoms, thoughts, feelings, and behavior patterns. Finally, doctors will compare your symptoms to those characterized in the DSM-IV-TR for mental health diagnosis2.

How is it Treated?
Atypical depression responds well to medications and psychotherapy3,4. Monoamine oxidase inhibitors (MAOIs) and other antidepressants, such as SSRIs and tricyclic antidepressants are the most common medications prescribed to treat atypical depression. However, you may need to try a combination of medications or several different types before finding one that works best for you.

Psychotherapy, which involves dialogue with a mental health professional about your condition and related issues, has also been found to be highly effective in treating atypical depression. During psychotherapy, or talk therapy, sessions, individuals can learn ways to cope, including:

Identifying and changing unhealthy thoughts or behaviors
Discussing relationships and experiences
Exploring different coping and problem-solving processes
Setting realistic goals
Finding ways to ease depressive symptoms

By: Arnold Lieber, MD

References
1 American Psychiatric Association. (2000). Mood Disorders. In Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) Washington, DC: Author.
2 “Atypical depression”. Mayo Clinic. Retrieved 2015-12-28.
3 Cristancho, Mario. “Atypical Depression in the 21st Century: Diagnostic and Treatment Issues”. Psychiatric Times. Retrieved 28 December 2015.
4 Singh T, Williams K (2006). “Atypical depression”. Psychiatry 3 (4): 33–9.

Besma (Bess) Benali, Clinical Social Work/Therapist, MSW, RSW, Counselling Ottawa Nepean. I am trained in Cognitive Behavioural Therapy (CBT), Brief Psychodynamic Therapy, ACT, and mindfulness. Clients come to me because they are struggling and feel like they are trapped in a darkness that no matter what they have tried (and many have tried therapy before) they can’t pull themselves out. I help my clients understand themselves in ways no one has ever taught them before allowing them to see positive changes.