Atypical Depression

Atypical depression is a subtype of depression that is characterized by specific symptoms that distinguish it from other types of depression. It is estimated that up to 40% of people with depression have atypical depression, making it a relatively common subtype. 

What is Atypical Depression?

Atypical depression is a subtype of major depressive disorder (MDD) that is characterized by specific symptoms that are not typical of other types of depression. The term "atypical" is used because the symptoms of this subtype are opposite to those of typical depression. 

Read more: What is Depression?

Causes of Atypical Depression

The exact cause of atypical depression is not known, but it is believed to be related to changes in the brain's chemistry. The neurotransmitters serotonin and norepinephrine are thought to play a role in depression, and changes in these chemicals may contribute to atypical depression.

Genetics may also play a role in the development of atypical depression. Studies have found that people with a family history of depression are more likely to develop atypical depression than those without a family history.

Additionally, stressful life events, such as a job loss, the death of a loved one, or a relationship breakup, can trigger atypical depression in some people.

Symptoms of Atypical Depression

The symptoms of atypical depression can include:

Mood reactivity: 

A person with atypical depression experiences temporary improvements in mood in response to positive events, such as receiving good news or spending time with loved ones.

Increased appetite or weight gain: 

A person with atypical depression may experience an increase in appetite, which can lead to weight gain.

Hypersomnia: 

A person with atypical depression may experience excessive sleepiness and sleep for longer than usual periods.

Heavy feeling in limbs: 

A person with atypical depression may feel physically weighed down or experience heaviness in their arms or legs.

Sensitivity to rejection: 

A person with atypical depression may be particularly sensitive to rejection and may have a fear of abandonment.

Low energy: 

A person with atypical depression may experience fatigue and have low energy levels.

Difficulty concentrating:

A person with atypical depression may have difficulty concentrating and making decisions.

Feelings of worthlessness:

A person with atypical depression may feel a sense of worthlessness and have low self-esteem.

Long-Term Complications of Atypical Depression

Atypical depression, like any other form of depression, can have long-term complications if left untreated or inadequately treated. Some of the potential long-term complications of atypical depression include:

Chronic depression: 

Atypical depression can progress to chronic depression if left untreated. Chronic depression is a persistent form of depression that lasts for more than two years and can significantly impact an individual's quality of life.

Substance abuse: 

Individuals with atypical depression may turn to alcohol or drugs as a means of self-medicating their symptoms. This can lead to the development of a substance use disorder, which can further complicate the treatment of depression.

Suicidal thoughts and behavior: 

Atypical depression, like other forms of depression, can increase the risk of suicidal thoughts and behavior. It is important for individuals with atypical depression to seek professional help if they experience any suicidal thoughts or behavior.

Physical health problems:

Depression, including atypical depression, has been linked to a range of physical health problems, including heart disease, diabetes, and chronic pain. Long-term depression can also weaken the immune system, making individuals more susceptible to infections.

Social and occupational impairment: 

Atypical depression can impact an individual's ability to function in social and occupational settings, leading to isolation, unemployment, and financial difficulties.

It is important for individuals with atypical depression to seek professional help and adhere to their treatment plan to reduce the risk of these long-term complications. 

Diagnosis of Atypical Depression

Healthcare professionals may use various assessments and tests to aid in the diagnosis of Atypical Depression. Trained Healthcare professionals will use DSM-5 to diagnose Atypical Depression. 

DSM-5 Criteria For Atypical Depression

Atypical depression is diagnosed using the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  Here are the DSM-5 criteria for diagnosing atypical depression:

A. The presence of a major depressive episode.

B. The presence of at least two of the following symptoms:

• Significant weight gain or increase in appetite

• Hypersomnia

• Heavy feeling in arms or legs

• A long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance)

• Mood reactivity (i.e., feeling better in response to positive events)

C. Criteria A and B are present for more days than not, for at least 2 consecutive weeks.

D. The episode is not better explained by another medical condition, substance use, or medication.

E. The episode is not attributable to the physiological effects of a substance or another medical condition.

F. The episode is not better explained by another mental disorder, such as persistent depressive disorder, bipolar disorder, or schizoaffective disorder.

G. There has never been a manic or hypomanic episode.

H. The symptoms cause significant distress or impairment in social, occupational, or other areas of functioning.

[ It is important to note that the DSM-5 criteria are intended for use by trained healthcare professionals and are not meant for self-diagnosis. A comprehensive evaluation by a healthcare professional is necessary to accurately diagnose atypical depression or any other mental health disorder.]

The DSM-5 also provides specifiers for atypical depression, which can help to further characterize the disorder. These specifiers include severity, course, and other clinical features.

The severity specifier is based on the number and intensity of symptoms, with mild, moderate, severe without psychotic features, and severe with psychotic features being the options. The course specifier describes the duration and pattern of symptoms, with options including single episode, recurrent, and partial remission. The DSM-5 also includes a specifier for seasonal patterns, which describes the presence of a regular temporal relationship between the onset of depressive episodes and a particular time of year.

It is important to note that the DSM-5 is a tool for diagnosing mental health disorders and is only one part of the diagnostic process. A thorough evaluation by a trained healthcare professional is necessary to make an accurate diagnosis and develop an appropriate treatment plan. Other assessment tools, such as physical examinations, blood tests, and other diagnostic interviews, may also be used in conjunction with the DSM-5 criteria to arrive at an accurate diagnosis.

Physical Examination

The first step in the diagnostic process is typically a physical examination. A doctor may perform a physical exam to rule out any underlying medical conditions that may be causing symptoms. For example, a thyroid disorder can mimic the symptoms of depression, and therefore, a blood test may be ordered to rule out this possibility.

Blood Tests

Blood tests may also be used to assess the levels of certain chemicals in the body that can affect moods, such as vitamin D, folate, and iron. These tests can help identify any deficiencies that may be contributing to depressive symptoms.

Screening Tools/Evaluation

In addition to physical examinations and blood tests, healthcare professionals may use screening questionnaires to assess the severity of depression symptoms. Standardized questionnaires, such as the Beck Depression Inventory and the Patient Health Questionnaire-9 (PHQ-9), can help healthcare professionals evaluate symptoms and determine the best course of treatment.

Psychiatric evaluation is another tool used in the diagnostic process for atypical depression. A mental health professional may conduct a comprehensive evaluation to assess symptoms and determine if the criteria for atypical depression are met. This evaluation may include a review of a person's medical history, family history, and current medications.

A structured clinical interview is another assessment tool that can aid in the diagnosis of atypical depression. The Structured Clinical Interview for DSM-5 (SCID) is a standardized clinical interview that is used to assess symptoms, medical history, family history, and other factors that may contribute to the development of atypical depression.

It is important to note that diagnosing atypical depression can be challenging because some of the symptoms may overlap with other medical conditions or side effects of medications. Therefore, a thorough evaluation by a trained healthcare professional is necessary to make an accurate diagnosis and develop an appropriate treatment plan.

Treatment of Atypical Depression

Like other subtypes of depression, atypical depression is treatable. Treatment typically involves a combination of medication and therapy.

Medications

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are commonly used to treat atypical depression. These medications work by increasing the levels of serotonin and norepinephrine in the brain, which can improve mood.

Psychotherapy

Therapy can also be beneficial in the treatment of atypical depression. Cognitive-behavioral therapy (CBT) is a type of therapy that has been shown to be effective in treating depression. CBT can help a person identify negative thought patterns and learn how to replace them with positive, more adaptive ones.

Electroconvulsive Therapy 

Electroconvulsive therapy (ECT) is another treatment option that may be used in severe cases of atypical depression.  This involves a brief electrical stimulation of the brain while the individual is under anesthesia. ECT is typically reserved for cases where other treatments have not been effective.

In conclusion, atypical depression is a subtype of major depressive disorder characterized by symptoms such as mood reactivity, hypersomnia, weight gain, heavy feeling in limbs, and sensitivity to interpersonal rejection. It is a complex and challenging condition to diagnose and treat, as its symptoms can overlap with those of other psychiatric and medical conditions. 

Early recognition and treatment of atypical depression are essential for improving outcomes and reducing the risk of long-term complications, such as chronic depression, substance abuse, and suicide. It is important for individuals who suspect they may be experiencing symptoms of atypical depression to seek help from a qualified healthcare professional. With proper treatment and support, individuals with atypical depression can achieve significant improvement in their quality of life.