Atypical Depression

Atypical depression is a subtype of depression characterized by persistent low mood and a loss of interest in things that usually bring pleasure. It differs from other types of depressive disorders in several ways, including excessive eating (and weight gain), excessive sleeping and extreme sensitivity to rejection by others.

What is atypical depression?

Atypical depression is a common kind of depression. The term ‘atypical’ doesn’t mean it is rare – this is just the term used to distinguish it from other forms of depression, such as melancholic or catatonic.^[1] As with other kinds of depressive disorder, the main symptoms are depressed mood and a loss of interest in things that usually bring pleasure, which can have a significant impact on a person’s life.

It differs from other forms of depression in various ways, notably overeating, oversleeping, extreme sensitivity to rejection by others and a feeling of heaviness or being weighed down. People with the atypical subtype of depression also find that their mood can lift when something good happens, which is not usually the case with other depressive subtypes or mood disorders.

Symptoms of atypical depression

According to the Diagnostic and Statistical Manual of Mental Disorders^[2], used by mental health professionals in the US to diagnose mental health problems, someone with atypical depression must first meet the diagnostic criteria for depression. The symptoms are as follows and a person must have at least five of them, including one of the top two, for two weeks or more:

• Low mood, most of the time
• Loss of interest in activities that would normally bring pleasure
• Significant weight loss or gain
• Sleep problems
• Restlessness or feeling slowed down
• Lack of energy or tiredness
• Feelings of worthlessness or guilt
• Difficulty concentrating
• Suicidal thoughts, plans or attempts

People with atypical depression will also experience some or all of the following:

• An increase in appetite or desire to overeat, leading to significant weight gain
• Hypersomnia, which is sleeping for much longer than usual
• A heavy feeling in the limbs
• Extreme sensitivity to rejection by other people
• A mood that responds to external events, which is to say that the low mood lifts if something positive happens

Causes of atypical depression

The exact causes of atypical depression are unknown. As with other forms of depression and other mental health problems, it is likely that there is a link between atypical depression and the levels of certain chemicals, called neurotransmitters, in the brain. Neurotransmitters include dopamine and serotonin, which can affect mood, sleep, appetite, and other functions.^[3]

There are also some known risk factors. The risk of developing atypical depression may be higher in someone who:

• Has a family member with atypical depression or a psychiatric disorder such as bipolar disorder^[1]
• Experienced trauma or abuse as a child
• Has experienced trauma or major stress in adulthood
• Has a history of substance abuse
• Has experienced a significant physical illness
• Has experienced a recent loss or bereavement

Diagnosing atypical depression

According to the Diagnostic and Statistical Manual of Mental Disorders^[2], atypical depression can be diagnosed if a person meets the criteria for depression, plus at least two of the symptoms for atypical depression listed above.

Diagnosis is done by a doctor or other mental health professional following a psychological evaluation, which includes a discussion of the signs and symptoms of depression, a review of medical history and sometimes questionnaires.

Prevention of atypical depression

Depression, including atypical depression, can’t necessarily be prevented. However, as with many mental health problems, taking steps to avoid stress, getting enough sleep and avoiding alcohol and drugs may reduce the risk of atypical depression developing.

Treatment for atypical depression

Effective treatment for atypical depression includes medication and therapy.^[4]

Medication for atypical depression

Your doctor or healthcare provider may prescribe an antidepressant medication to help alleviate the depressive symptoms of atypical depression. These work by regulating chemicals in the brain that help control mood, sleep, and appetite, among other functions.

Therapy for atypical depression

There are several different kinds of therapy that can help patients with depression, including:

• Cognitive behavioral therapy (CBT), which explores how we think and act and can help us find ways to cope with difficult emotions.
• Interpersonal therapy, which looks at an individual’s personal relationships and how they might be improved.
• Psychodynamic therapy, which looks at our unconscious thoughts and our past, and how this might be affecting our low mood.

Self-care for atypical depression

Living with atypical depression can be difficult but there are things you can do to support your own wellbeing:

Talk

Opening up to someone you know you can trust can help you feel less alone.

Take care of your physical wellbeing

Staying active, keeping your blood sugar on an even keel and avoiding alcohol and drugs will serve your mind as well as your body.

Try mindfulness

Mindful meditation has been linked to lower levels of depression ^[5] and there are many free and low-cost apps that will guide you in short daily sessions.

Get outside

Research has shown that ‘ecotherapy’ – being outdoors in nature for exercise or activities such as gardening – can improve wellbeing.^[6]

FAQs about atypical depression

How common is atypical depression?

Around 21 million Americans have had an episode of major depression.^[7] Clinical studies show that between 15 and 29 per cent of people with depression have atypical depression.^[8]

Atypical depression vs melancholic depression – what is the difference?

Atypical depression and melancholic depression share many common characteristics, but have a few key differences.^[2]

All subtypes of depression have the core symptoms of persistent low mood and a loss of interest in things that would usually give the person pleasure.

People with atypical depression have specific atypical symptoms including overeating and weight gain, and oversleeping. They will also find their mood lifts when something good happens.

In contrast, someone with melancholic depression may experience a loss of appetite and lose weight and is likely to wake up early rather than oversleep. Their mood is not usually lifted by external, positive events.