An Overview of Atypical Depression

Atypical Depression: Causes, Symptoms, Treatment, Outlook

An Overview of Atypical Depression

Depression is a condition that causes people to feel ongoing sadness and lose interest in activities they once enjoyed.

Additional symptoms can include social isolation, feelings of hopeless and worthlessness, insomnia (difficulty falling and/or staying asleep), decreased appetite with weight loss, fatigue, difficulty concentrating and thoughts of death or suicide.

Depression can interfere with one’s ability to perform daily tasks. It can also contribute to a wide range of physical problems and negatively impact one’s relationships.

What is atypical depression?

Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms vary from the traditional criteria. One symptom specific to atypical depression is a temporary mood improvement in response to actual or potential positive events. This is known as mood reactivity.

How common is atypical depression?

Depression is quite prevalent, affecting approximately 121 million people worldwide. Despite its name, atypical depression is actually quite common affecting 18 to 36% of people with a depressive disorder.

Atypical depression is at least twice more ly to affect women than men. In addition, atypical depression tends to begin at an earlier age (teen years and early 20s) and last longer (often becoming a chronic condition) than typical depression.

In addition to mood reactivity (described under “what is atypical depression”), people with atypical depression have at least two of the following symptoms:

  • Increase in appetite and/or significant weight gain
  • Excessive sleepiness (hypersomnia)
  • Heavy feeling in the arms or legs (also called leaden paralysis)
  • Intense reaction and increased sensitivity to criticism or rejection, which results in significant social and work impairment

These symptoms differ from typical depression symptoms, which often include a lossof appetite and insomnia (difficulty falling and/or staying asleep). In addition, the mood of people with typical depression usually does not improve, even when good things happen.

What causes atypical depression?

Doctors do not know exactly why some people experience depression or atypical depression. However, theories include:

  • Impaired functioning of neurotransmitters (chemicals that carry brain signals to other parts of the body) and/or neuroreceptors (the “receivers” of the signals)
  • Genetics (having a family member with mood disorders including bipolar disorder and dysthymia [long-term depression] may also contribute to the development of atypical depression
  • Trauma
  • Stress

Additional risk factors for the development of atypical depression include:

  • Negative childhood experiences
  • Emotional, physical or sexual abuse
  • Significant illness
  • Grief following a significant loss
  • History of substance abuse

Diagnosis of atypical depression is made based upon an evaluation of your symptoms. A doctor will perform a physical exam to rule out physical causes of depressive symptoms such as a thyroid disorder.

He or she will ask if you have a family history of mental health issues or depression.

Your doctor will also ask about your behaviors and feelings and may refer you to a behavioral health specialist (psychologist or psychiatrist) for diagnosis and treatment.

Atypical depression often responds well to treatment. Your treatment may vary depending on the condition’s severity. Treatments for atypical depression include:

  • Antidepressant medications to help regulate your brain chemistry
  • Lifestyle changes such as exercising or quitting alcohol or recreational drug use
  • Psychotherapy (talking with a mental health professional) to:
    • Learn coping strategies for negative or unhealthy thoughts
    • Improve interpersonal relationships
    • Resolve trauma

Some of the medications used to treat atypical depression can have side effects. Side effects can include:

  • Nausea/diarrhea
  • Loss of appetite
  • Headaches
  • Insomnia
  • Loss of sex drive

Side effects usually improve as your body adjusts to the medication. If side effects don’t lessen, your doctor can help you by suggesting different types of medications that may work better for you.

What are the complications associated with atypical depression?

People with atypical depression may experience complications and other mental health disorders including:

  • Alcohol or drug use as a coping method
  • Binge eating and weight gain due to increased appetite
  • Increase in anxiety
  • Relationship conflict
  • Thoughts of suicide (suicidal ideation)

Atypical depression is not always preventable. Steps you can take to reduce your risk of the disorder include:

  • Manage stress
  • Seek medical help at the first sign of depression
  • Talk about your feelings with someone you trust

Depression is a serious medical condition with serious potential outcomes if left untreated including:

  • Increased risk of suicide
  • Worsening of medical illness
  • Increased conflict in relationships
  • Increased risk of substance abuse
  • Increased missed time and loss of effort at work

However, with appropriate treatment, 70 to 80% of individuals with a major depressive disorder can greatly improve their symptoms, although as many as 50% of patients may not respond to the initial treatment trial.

Seek emergency medical help if you have thoughts of harming yourself or suicide. If you are experiencing sad mood or a loss of interest in previously enjoyed activities for a period of 2 weeks, make an appointment with your healthcare provider or talk to someone you trust such as a friend, family member or faith leader.

What questions should I ask my doctor?

If you have atypical depression, you may want to ask your doctor:

  • What is the cause of my atypical depression?
  • What is the best treatment for this type of depression?
  • What signs of complications should I look out for?
  • Should I follow up with a different kind of doctor?
  • What support resources are available to me?

A variety of organizations offer resources to help educate and empower people with Depression and Atypical Depression. Here are some useful resources for more information and support.


Atypical Depression: Symptoms & Causes

An Overview of Atypical Depression

Depression is one of the most common mental disorders, but not all cases of depression are a. While “typical” depression might be characterized by low energy, loss of appetite, or persistent sadness regardless of circumstances, some cases of depression involve different symptoms.

Atypical depression is less common than major depressive disorder, but still represents a considerable number of cases of depression. Although it shares common features with typical depression, atypical depression includes some unique signs and symptoms.

What Is Atypical Depression?

Atypical depression is a subtype of major depressive disorder characterized by several symptoms line with those of typical depression. Atypical depression is a separate diagnosis from typical depression and was discovered patients with different symptoms who responded better to specific medications. 

When comparing atypical vs. typical depression, people with atypical depression are able to temporarily feel better in response to good news or a happy event, and may also have unusual symptoms related to sleep and appetite. It’s estimated that around 40% of people with major depression or dysthymia meet criteria for atypical depression.

Symptoms of Atypical Depression

There are several symptoms that help differentiate between typical and atypical depression. For example, atypical depression symptoms include:

  • Mood reactivity, or the ability to brighten in response to something good
  • A significant increase in appetite or weight gain
  • Excessive daytime sleeping
  • Feeling heavy or paralyzed in the arms and/or legs
  • Extreme sensitivity to rejection or interpersonal conflict

These symptoms are notably different from typical depression, which is characterized by persistent low mood, decrease in appetite and reduced sleep. Some sufferers of atypical depression suggest that they have experienced many of these symptoms all of their lives and that they can be significantly impairing. 

The symptoms of atypical depression share similarities with symptoms of bipolar disorder, certain personality disorders, and chronic fatigue syndrome. Because of this, atypical depression may sometimes be misdiagnosed or require further investigation to ensure the correct diagnosis.

What Causes Atypical Depression?

Atypical depression can be part of different types of mood disorders, including bipolar disorder or dysthymia. Because atypical depression can be related to many types of mood disorders, the causes and underlying risk factors may vary. 

The answer to what causes atypical depression is not straightforward. As with many mental disorders, atypical depression is ly caused by a combination of genetic, personal and environmental risk factors.

More specifically, the causes of atypical depression have been linked to having a family history of the condition, as well as some biological differences in brain function. In combination, the personality trait of being sensitive to rejection is a key feature of atypical depression.

Other factors related to atypical depression include being female, having a higher body mass index, metabolic syndrome and abnormally low blood levels of cortisol. However, it’s hard to know whether these are causes or side effects of atypical depression.

Diagnosing Atypical Depression

An atypical depression diagnosis relies on the presence of several unique criteria.

As presented in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) for atypical depression, a diagnosis of the condition requires the presence of mood reactivity (the ability to brighten) as well as at least two other symptoms including increased appetite or weight gain, excessive sleep, leaden paralysis and long-term sensitivity to rejection. 

While there is no clear or simple test for atypical depression, diagnostic criteria are clearly outlined in the DSM-V. 

How Is Atypical Depression Treated?

Atypical depression treatment usually has a slightly different strategy and prognosis than typical depression treatment. Medication is one common treatment approach for atypical depression.

Initially, research suggested that atypical depression had a better response to medication monoamine oxidase inhibitors than selective serotonin-reuptake inhibitors (two types of antidepressant medications).

However, further research has shown that the difference in response to medication is actually very small.

Another common atypical depression treatment option is cognitive-behavioral therapy. Interestingly, treatment response for atypical depression can also be improved with regular exercise.

Although atypical depression can often occur at the same time as other mental health conditions, rates of remission are typically higher than those associated with typical depression.

In the end, the best treatment strategy will depend on the individual, the severity of illness and any co-occurring conditions present.

If you or someone you love is suffering from atypical depression and a related substance use disorder, contact The Recovery Village today to discuss treatment options.

  • Sources

    Singh, Tanvir, and Williams, Kristi. “Atypical depression.” Psychiatry, April 2006. Accessed June 21, 2019.

    Baumeister, Harald, and Gordon, Parker. “Meta-review of depressive subtyping models.” Journal of Affective Disorders, September 1, 2011. Access June 21, 2019.

    Łojko, Dorota, and Janusz K Rybakowski. “Atypical depression: current perspectives.” Neuropsychiatric disease and treatment, September 20, 2017. Accessed June 21, 2019.


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