The manner in which people experience depression can vary drastically between different individuals. There are several different types of depression, one of the most common forms being atypical depression, known clinically as major depressive disorder (MDD) with atypical features. Those with atypical depression are able to experience a reprieve from depressive symptoms when encountering a pleasurable moment.
MDD, also called clinical depression, significantly affects how people feel, think, behave, and experience their world. In addition to feeling sad or irritable, a common symptom of MDD is experiencing a loss of interest in things that were previously enjoyable. What this means is that even when a person with MDD has a positive life experience, it is unlikely to boost their mood.
The symptoms of atypical depression are similar to MDD. The major difference is that people who have MDD with atypical features may experience an improvement in their mood when something good happens to them. They may also experience other symptoms that are atypical or different from a classic MDD diagnosis.
Symptoms of Atypical Depression
In general, the symptoms of atypical depression vary in their presentation from person to person. However, they are always characterized by some combination of core symptoms of MDD along with atypical symptoms.
Core symptoms of MDD include:
- Feeling sad, down, or hopeless
- Irritability
- Changes in sleeping patterns (too much or too little)
- Changes in weight and/or appetite
- Low energy and feeling tired easily
- Cognitive difficulties (memory, focus, decision making)
- Thoughts or talk about ending one’s life
Symptoms specific to atypical depression include:
- Mood improves or brightens in response to positive news or enjoyable activities
- Significant weight gain
- Increase in appetite
- Heavy feeling in limbs
- Sleeping for extended periods of time at night or during the day
- Extreme sensitivity to rejection or perceived criticism
- No presence of melancholic features or catatonic features during the same period
Causes of Atypical Depression
The exact cause of MDD with atypical features is unknown, but there are factors that put people at an increased risk.
- Age and gender differences may increase the likelihood of a person experiencing atypical symptoms of depression. Women diagnosed with MDD are more likely to experience atypical symptoms.[1] Furthermore, atypical depression tends to have an earlier onset with higher rates present among teenagers and young adults.[2]
- Life trauma is another identified risk factor for developing atypical symptoms. In particular, children who were neglected or abused may be at increased risk for later developing MDD with atypical features.[3]
- Genetics may also play a role in the development of the disorder. People with a family history of MDD, alcohol abuse, or drug abuse are more likely to develop MDD.[4]
- Certain medical conditions can also elevate a person’s risk. You are more likely to experience atypical features of MDD if you have a history of other mental health disorders such as anxiety, bipolar disorder, or personality disorders. Personal history of substance abuse is another factor that can exacerbate symptoms or increase the likelihood of developing atypical depression.
Atypical Depression Treatment Options
There are a variety of treatment approaches for atypical features. Ideally, treatment will include a combination of medication, talk therapy, and lifestyle changes.
Medications
Once diagnosed with atypical depression, your doctor may prescribe an antidepressant. Although the majority of commonly used medications for MDD are helpful in the presence of atypical features, some people with atypical depression do not respond well to tricyclic antidepressants. Therefore, physicians will often prescribe monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs) which have been proven effective for the disorder. Your doctor may prescribe a single medication or a combination of medications, known as dual therapy or augmentation therapy.[1]
There is also evidence that a narcolepsy medication called Modafinil may be particularly effective in treating symptoms of atypical depression.[5]
Talk Therapy
Psychotherapy, or talk therapy, can be an excellent part of a treatment plan for atypical depressive symptoms. Talk therapy focuses on working through many of the symptoms, unhelpful thought patterns, and finding healthy coping mechanisms. Cognitive behavioral therapy has been shown to be particularly effective in reducing symptoms of atypical depression when used in conjunction with MAOIs.[6]
There are many different types of therapy, such as group therapy, dialectical behavior therapy, or interpersonal therapy that may be effective. It is important to find a therapist you enjoy working with in order to optimize your progress in talk therapy.
Lifestyle Changes
Positive lifestyle changes can be implemented as part of a treatment plan to reduce symptoms of atypical depression. Regular exercise and choosing healthier whole foods can be instrumental in improving overall well-being and reducing some of the symptoms.[7] Implementing a daily meditation practice, journaling, and light exposure therapy are also effective ways to reduce stress, improve well-being, and better manage daily symptoms. Start out by incorporating a positive lifestyle change like meditation for just a couple of minutes every day.
In Summary
Living with atypical depression can be difficult and sometimes confusing. Do not be afraid to reach out for help if you are experiencing symptoms that are interfering with your quality of life. You should always seek the expert opinion of a mental health professional who can guide you about an appropriate treatment plan based on your symptoms. In addition to talk therapy, medications, and lifestyle changes, make sure you have a support network and surround yourself with friends and family or join a support group.
References
- Marcus, S. M., Kerber, K. B., Rush, A. J., Wisniewski, S. R., Nierenberg, A., Balasubramani, G. K., Ritz, L., Kornstein, S., Young, E. A., & Trivedi, M. H. (2008). Sex differences in depression symptoms in treatment-seeking adults: confirmatory analyses from the Sequenced Treatment Alternatives to Relieve Depression study. Comprehensive psychiatry, 49(3), 238–246. https://doi.org/10.1016/j.comppsych.2007.06.012
- Singh, T., & Williams, K. (2006). Atypical depression. Psychiatry (Edgmont (Pa. : Township)), 3(4), 33–39.
- Lippard, E., & Nemeroff, C. B. (2020). The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders. The American journal of psychiatry, 177(1), 20–36. https://doi.org/10.1176/appi.ajp.2019.19010020
- Quello, S. B., Brady, K. T., & Sonne, S. C. (2005). Mood disorders and substance use disorder: a complex comorbidity. Science & practice perspectives, 3(1), 13–21. https://doi.org/10.1151/spp053113
- Vaishnavi, S., Gadde, K., Alamy, S., Zhang, W., Connor, K., & Davidson, J. R. (2006). Modafinil for atypical depression: effects of open-label and double-blind discontinuation treatment. Journal of clinical psychopharmacology, 26(4), 373–378. https://doi.org/10.1097/01.jcp.0000227700.263.75.39
- Jarrett, R. B., Schaffer, M., McIntire, D., Witt-Browder, A., Kraft, D., & Risser, R. C. (1999). Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Archives of general psychiatry, 56(5), 431–437. https://doi.org/10.1001/archpsyc.56.5.431
- Rethorst, C. D., Tu, J., Carmody, T. J., Greer, T. L., & Trivedi, M. H. (2016). Atypical depressive symptoms as a predictor of treatment response to exercise in Major Depressive Disorder. Journal of affective disorders, 200, 156–158. https://doi.org/10.1016/j.jad.2016.01.052
Dr. Lisa Batten has a master’s degree in clinical psychology and a Ph.D. in developmental psychology. She has over a decade of experience in clinical research and specializes in writing about mental health, wellness, nutrition, and fitness.