Atypical Depression

What is atypical depression?

Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms stray 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. Other key symptoms include increased appetite and rejection sensitivity.

“Atypical” doesn’t mean that the condition is odd or unusual. It’s just different from “typical” depression.

What is the difference between typical and atypical depression?

Typical and atypical depression are both mental health conditions that involve prolonged feelings of sadness and hopelessness. The main difference is that in atypical depression, your mood can temporarily brighten as a result of positive events (such as a fun birthday party). In typical major depression, your depressed mood is usually constant.

Typical depression often causes a loss of appetite and insomnia (difficulty falling and/or staying asleep), whereas atypical depression usually causes an increase in appetite and feeling sleepy despite sleeping enough or too much.

In addition, atypical depression tends to begin at an earlier age and last longer (often becoming a chronic condition) than typical depression.

Who gets atypical depression?

Atypical depression is twice as likely to affect women and people assigned female at birth than men and people assigned male at birth. It tends to begin in the teen years or early 20s.

How common is atypical depression?

Despite its name, atypical depression is quite common. It affects 15% to 36% of people with a depressive disorder. Approximately 121 million people worldwide have a depressive disorder.

What are the symptoms of atypical depression?

The main sign of atypical depression (in comparison to typical depression) is that your mood temporarily improves in response to positive events. This usually doesn’t happen in typical depression.

In addition, 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 their arms or legs (also called leaden paralysis).
• Increased sensitivity to criticism or rejection, which results in significant social and occupational impairment. The emotional reactions may happen after imagined, anticipated or real rejection.

Other depressive symptoms that apply to atypical depression include:

• Feeling very sad or hopeless.
• Not enjoying things that used to bring you joy.
• Being easily irritated or frustrated.
• Having a difficult time concentrating or remembering things.

What causes atypical depression?

Researchers don’t know exactly why some people experience depression or atypical depression. But they believe the following factors contribute to its development:

• Impaired functioning of neurotransmitters (chemicals that carry brain signals to other parts of your body) and/or neuroreceptors (the “receivers” of the signals).
• Genetics. Having a biological family member with mood disorders, including bipolar disorder and persistent depressive disorder, may contribute to the development of atypical depression.
• Trauma.
• Chronic stress.

Additional risk factors for atypical depression include:

• History of bipolar disorder and/or anxiety.
• Negative childhood experiences (also called adverse childhood experiences).
• Emotional, physical or sexual abuse.
• Significant illness, such as a major injury or a chronic illness.
• Grief following a significant loss.
• History of substance use.

How is atypical depression diagnosed?

Healthcare providers diagnose atypical depression based on a thorough understanding of your symptoms and medical and mental health history.

A provider will likely perform a physical exam and may order certain blood tests to rule out physical causes of depressive symptoms, such as thyroid disease.

The provider may refer you to a mental health specialist (psychologist or psychiatrist) for diagnosis and treatment.

What is the treatment for atypical depression?

Atypical depression often responds well to treatment. Your treatment may vary depending on the condition’s severity. Treatments for atypical depression usually include psychotherapy (talk therapy) and/or medication.

Lifestyle changes, such as exercising regularly or quitting alcohol or recreational drug use, can also help improve symptoms.

Psychotherapy

“Psychotherapy” is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors.

Psychotherapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to help you function better and increase your well-being.

Mental health professionals often use cognitive behavioral therapy (CBT), one type of psychotherapy, to help treat atypical depression. During CBT, your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits.

Antidepressant medications

Various medications are available to treat depression (antidepressants), including atypical depression. There’s no single best antidepressant, and the best one for you depends on your symptoms and individual needs.

Usually, antidepressants help balance your levels of neurotransmitters, including serotonin, dopamine and norepinephrine.

Currently, there are six different classes of medications approved to treat depression, including:

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin and noradrenaline reuptake inhibitors (SNRIs).
• Tricyclic antidepressants (TCAs).
• Monoamine oxidase inhibitors (MAOIs).
• Norepinephrine and dopamine reuptake inhibitors (NDRIs).
• Noncompetitive N-methyl-D-aspartate receptor antagonists.

Historically, people with atypical depression have responded best to MAOIs. However, this class of antidepressants has more severe side effects than other classes. There are also significant dietary restrictions. Because of this, healthcare providers don’t prescribe MAOIs as often.

Your provider will work with you to find the best medication for you.

How can I prevent atypical depression?

You can’t always prevent atypical depression. Steps you can take to reduce your risk include:

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

What is the prognosis for atypical depression?

The prognosis (outlook) for atypical depression depends if it’s properly treated.

Atypical depression is a serious medical condition with potential complications if it isn’t treated, including:

• Binge eating and weight gain due to increased appetite.
• Increased risk of suicide.
• Worsening of co-occurring medical conditions.
• Increased conflict in relationships.
• Increased risk of substance use.
• Increased missed time and loss of effort at work or school.

With appropriate treatment, 70% to 80% of people with depression experience a significant improvement in symptoms. But as many as 50% of people may not respond to the initial treatment. It’s important to keep trying to find the right treatment plan that works for you.

When should I see my healthcare provider?

If you have symptoms of atypical depression, see a healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.

If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone will be available to help you 24/7.

A note from Cleveland Clinic

Atypical depression is a specific type of depression. Like depression and other mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Talk to a healthcare provider if you’re experiencing symptoms of atypical depression. Mental health professionals can offer treatment plans that can help you manage the condition.