Atypical Depression

This article is part of the Depression Symptoms Guide. In this part of the series, we will examine the type of depression known as Atypical Depression.

Atypical depression is a type of unipolar disorder, and is a subtype of major depressive disorder and dysthymia, characterised by mood reactivity — being able to experience improvements in mood due to positive events. This contrasts with other forms of depression, where sufferers cannot experience improvements in mood even when good things happen.

Despite its name, atypical depression accounts for up to 40% of people with depression, making it the most common subtype of depression.^[1] Atypical depression also tends to onset earlier in life than other forms of depression, often during the teenage years.

Patients suffering from atypical depression are believed to be more likely to suffer from other psychiatric syndromes such as panic disorder, social phobia, avoidant personality disorder, or body dysmorphic disorder.

Atypical depression may also be linked to thyroid dysregulation, with some studies finding subtle thyroid abnormalities in people with atypical depression, and another study suggesting that patients may benefit from triiodothyronine, a medication used to treat hypothyroidism.^[2]

Symptoms

The main characteristic of atypical depression that distinguishes it from other forms of depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. Other symptoms may include:

• An increase in appetite, often accompanied by significant weight gain.
• Hypersomnia.
• Leaden paralysis (a heavy, leaden feeling in the arms or legs).
• A history of sensitivity to interpersonal rejection resulting in significant occupational or social impairment.

Diagnosis

A diagnosis for atypical depression usually involves blood tests and a medical examination to rule out other causes for the symptoms. Particular attention is often paid to issues concerning thyroid function, due to the possible links between the two conditions.

In diagnosing atypical depression, the DSM-IV-TR^[3] requires that the patient experience:

• Mood reactivity, and
• At least two of the following:
1. Significant weight gain or increase in appetite, or
2. Hypersomnia, or
3. Leaden paralysis, or
4. A long-standing pattern of sensitivity to interpersonal rejection.

Getting Help

Identifying whether you are suffering from atypical depression can be difficult, because many of the symptoms might be considered personality traits, or reactions to difficult times in your life.

Just like major depressive disorder and dysthymia though, atypical depression can develop into a very serious and dangerous form of depression, so if you are experiencing any of the symptoms listed above, you should visit your doctor to discuss how you’re feeling.

References

Nierenberg AA, Alpert JE, Pava J, Rosenbaum JF, Fava M, (1998), Course and Treatment of Atypical Depression, Journal of Clinical Psychiatry

Iosifescu DV, Nierenberg AA, Mischoulon D, Perlis RH, Papakostas GI, Ryan JL, Alpert JE, Fava M, (2005), An Open Study of Triiodothyronine Augmentation of Selective Serotonin Reuptake Inhibitors in Treatment-Resistant Major Depressive Disorder, Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston

American Psychiatric Association, ed (June 2000), Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR (Fourth Edition (Text Revision) ed.), American Psychiatric Publishing, Inc