What Is Atypical Depression? Diagnostic and Treatment Considerations

Many people struggle with depressed mood, negative thoughts, or even thoughts of suicide. Recent statistics published by the World Health Organization indicate more than 322 million people worldwide are experiencing symptoms related to depression alone, which makes mental health conditions the leading cause of disability around the world. This has led to increased attention, screening, and treatment options.

There are different types (or subtypes) of depression. To put this in perspective, think in terms of physical health issues. When it comes to, say, diabetes, heart disease, or cancer, there are not only different types of these conditions but also different treatment options, depending on the symptoms. Not all people living with depression have the same type, and no single treatment approach is appropriate for everyone. One form of depression that we do not hear a lot about is atypical depression.

In 1948, the term “atypical depression” was first used to describe major depression among people with symptoms of agitation, paranoia, and perplexity. Over time, it was categorized at various points as a type of depression secondary to schizophrenia, a form of brief depression, and even the type of depression experienced with bipolar. Today, it is categorized as a specifier/subtype of major depression or dysthymia. Characteristics of atypical depression include mood reactivity and at least two of the following: increased appetite or significant weight gain, hypersomnia (more than 10 hours at a time), heavy limb sensation lasting more than an hour each day, or interpersonal rejection sensitivity (hyper-alertness to the social reactions of other people).

Atypical depression shares a lot of the same indicators as the “normal” type of depression we often hear about. The major difference is referred to as mood reactivity. Simply put, mood reactivity is when your mood improves in response to a positive event or situation. This conflicts with popular understanding of what depression looks like: a person who is depressed is thought to present as sad, tearful, generally unhappy, or perhaps even suicidal. A person who smiles in response to a happy event in their life can’t possibly be depressed, right? Nothing could be further from the truth. Atypical depression is not your garden-variety depression (hence the name).

Treatment for Atypical Depression

What can you do if your mental health provider says you have symptoms of atypical depression? Here are three treatment considerations:

1. Pharmacogenomics

Pharmacogenomics (or drug-gene testing) is the study of how a person’s genes can affect their response to a particular class of drugs. Genetic testing for psychiatric medication is on the rise. Many medical and mental health providers are referring people for genetic testing to find the most appropriate medication to prescribe, based on their genetic makeup. This type of testing can help your provider identify medications that are most likely to work, avoid drugs that might have unpleasant side effects, and even to decide if closer monitoring is needed.

Therapy is an effective treatment for depression. With individual therapy, you have the opportunity to explore some of the things in your life that may either cause or increase symptoms, and you can learn ways to manage those symptoms and improve your quality of life.

2. Medication

Atypical depression often responds well to certain types of medication—specifically those developed to address “typical” depression. Historically, atypical depression was primarily treated with a class of medications known as MAOIs (monoamine oxidase inhibitors). Although these medications can be effective, they are not widely used due to potentially significant side effects and dietary restrictions (no cheese, alcohol, or even caffeine).

Another popular class of medication used to treat atypical depression are SSRIs (selective serotonin reuptake inhibitors). These medications (including Zoloft, Prozac, and Paxil) are among the most widely used to treat all types of depression. This class of medication is popular because it generally comes with fewer side effects and is considered safer compared to MAOIs.

Medication is included here as a separate action item because one of the primary reasons some people prescribed medication do not report improvement in symptoms is lack of compliance in taking them.

3. Counseling/therapy

Therapy is an effective treatment for depression. With individual therapy, you have the opportunity to explore some of the things in your life that may either cause or increase symptoms, and you can learn ways to manage those symptoms and improve your quality of life. Working with a mental health professional in an open, caring, nonjudgmental environment can allow you the opportunity to explore unhelpful thought patterns, develop productive coping strategies, or work through issues that may be contributing to your experience.

Talk to a mental health professional and/or your health care provider if you believe you might be experiencing depression in any form.

References:

1. Cristancho, M.A., O’Reardon, J.P., & Thase, M.E. (2012, November 20). Atypical depression in the 21^st dentury: Diagnostic and treatment issues. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/major-depressive-disorder/atypical-depression-21st-century-diagnostic-and-treatment-issues
2. Łojko, D., & Rybakowski, J.K. (2017). Atypical depression: Current perspectives. Neuropsychiatric Disease and Treatment, 13, 2447-2456. doi: 2147/NDT.S147317
3. Quitkin, F.M. (2002). Depression with atypical features: Diagnostic validity, prevalence, and treatment. Primary Care Companion Journal of Clinical Psychiatry, 4(3), 94-99.

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