What Is Atypical Depression?
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Depression isn't the same for everyone. In fact, scientists have identified several different subtypes of depression, including major depression, dysthymia (mild, persistent depression), bipolar depression, seasonal affective disorders (winter or summer depression), postpartum depression, situational depression, and atypical depression.
All these disorders are considered mood disorders. This last one, atypical depression, has much in common with other forms of depression, but it also has some unique features.
What is atypical depression?
Scientists and psychiatrists have often disagreed on the symptoms, course, and treatment of atypical depression. The American Psychiatric Association DSM-5 (a diagnostic and statistical manual) lists atypical depression as a "specifier" of major depressive disorder and persistent depressive disorder. Atypical depression is depression that has specific features and diagnostic criteria that are not usually associated with depression.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains up to date criteria for the diagnosis and treatment of various mental disorders. According to this statistical manual, atypical depression differs from typical depression, since your mood can brighten temporarily in response to positive events. Whereas in typical depression, your mood will remain constanlty low. This manual of mental disorders (DSM-5) allows therapists and their patients to clearly communicate, so that they can provide the best diagnosis, treatment, and care possible.
How common is atypical depression?
About 16.2 million U.S. adults have had at least one episode of major depressive disorder. Although it's called atypical, depression with atypical features is quite common. Estimates of the prevalence of atypical depression vary greatly from study to study. Somewhere between 15% and 40% of patients with depression are thought to experience atypical depression. Atypical depression is also two to three times more common in women.
What's so atypical about atypical depression?
Two things set atypical depression apart from general depressive disorders and other mental health disorders: its symptoms and the treatments that tend to be most effective. The symptoms of atypical depression run counter to what most people think of as depression. Symptoms that depression with atypical present include loss of appetite, trouble sleeping, and feeling sad much of the time. This is not the case with atypical depression.
Some symptoms of atypical depression are like those of other forms of depression. These include:
Loss of enjoyment
Sadness
Restless or rundown feeling
Fatigue or loss of energy
Feelings of hopelessness, worthlessness, or guilt
Trouble concentrating and making decisions
Thoughts of death or suicide
A generally depressed mood
Substance abuse
However, depression with atypical features others symptoms as well. People with atypical depression may have some or all the following symptoms, too.
Mood reactivity
Mood reactivity means that you react to positive events with positivity, even though you are depressed. While a person with typical depression continues to feel bad no matter what happens, a person with atypical depression can feel happy when something good happens.
Sensitivity to rejection
People with atypical depression tend to have high rejection sensitivity. When you have atypical depression, you notice every possible rejection and expect rejection in many different circumstances. You may feel rejected by your lover or friend at the slightest hint that you don't have their 100% approval and acceptance. Rejection can trigger a major depressive episode.
Leaden paralysis
Leaden paralysis refers to a feeling of heaviness in your arms or legs. If you feel that sense of heaviness for at least one hour a day or more, it can be a sign of atypical depression.
Excessive sleeping
People with atypical depression tend to sleep more than usual. Because of experiencing a depressed mood, they may oversleep in the morning and take long naps throughout the day. If you sleep 10 or more hours a day, or two hours more than usual, it may be a sign you have atypical depression.
Increased appetite and weight gain
Depression and weight gain are often related, since symptoms may cause a person to turn to food as a coping mechanism. If patients with atypical depression choose to eat foods that are high in fat and sugar, as many comfort foods are, symptoms could become worse.
Premenstrual symptoms
Women with PMS and atypical depression not only have increased appetites, but they also tend to prefer carbohydrates and sweets like chocolates during the premenstrual phase. This may be their body's way of self-medicating to relieve the symptoms of PMS and depression temporarily.
Atypical depression’s relationship with other mental health conditions
Often, people with atypical depression also have other mental conditions. Dysthymic disorder, which is a chronic form of depression, can be a serious illness. These conditions influence the way people are affected by atypical depression. Their other conditions may also contribute to the depression, making it harder for them to overcome it and move on to better mental health.
Anxiety disorders
Anxiety disorders are often associated with atypical depression. Thirty percent of people with social phobia have atypical depression. Thirty percent of people with obsessive-compulsive disorder have it. Sixty-four percent of people with panic disorder also have atypical depression.
Bipolar disorder
Clinicians often notice that people with bipolar disorder are more prone to having atypical depression, but little scientific research has been done to establish the exact prevalence. At this point, all that can be said is that people with bipolar disorder have atypical symptoms during the depressed phase slightly more often than people with unipolar depression do. Bipolar disorder can be successfully treated with medications and therapy, yet some people develop substance use falsely believing street drugs will make them feel better.
Seasonal affective disorder
People with seasonal affective disorder experience two of the main atypical depression symptoms more often than people with non-seasonal depression. They are more likely to overeat and oversleep. As a result of this, weight gain is a common symptom of seasonal affective disorder. However, they aren't any more likely to have a sensitivity to rejection.
Personality disorders
Personality disorders that create emotional instability are often associated with atypical depression. These include borderline and avoidant personality disorders. This may be partly due to the problems people with these disorders have with interpersonal relationships and emotional control.
Neuropsychiatric disease
This type of mental disorder deals with neurology and psychiatry. In most cases, this type of disorder begins with some type of brain malfunction. These types of conditions include addictions, degenerative diseases, eating disorders, neurotic disorders, sleep disorders, and psychosis.
Melancholic depression
Melancholic depression is considered a major depressive disorder. The American Psychiatric Association recognizes melancholic depression as a specifier for major depressive disorder rather than a separate mental illness. In the Diagnostic and Statistical Manual (DSM-5), melancholic depression is characterized by a loss of pleasure and various physical symptoms.
What causes atypical depression?
It isn't yet clear whether the causes of atypical depression are mostly the same as the causes of other forms of depression as many of the risk factors are the same. Still, there may be some differences in the way atypical depression occurs.
Biological causes
Atypical depression often starts during the teenage years, though it can become a chronic, even life-long struggle. Differences in the brain may be the cause. These differences can include the functions of nerve receptors and the nerves themselves, and the chemical balance in the brain.
Atypical depression may have a genetic component, although it hasn't been identified precisely yet. Drug or alcohol misuse can create brain changes, which can increase your risk of atypical and other types of depression.
For atypical depression specifically, the hypothalamus may have a significant impact. As the hypothalamus responds to stress, the pituitary gland secretes adrenocorticotropic hormone (ACTH), which prompts the adrenal glands to release cortisol. If you have certain conditions, such as Cushing's disease, the pituitary is damaged, so it doesn't stop sending ACTH. The same process happens with seasonal depression, postpartum depression, and chronic fatigue syndrome. The result is eating disorders or overeating and oversleeping.
Family history
If you have one or more blood relatives who have had depression, alcoholism, bipolar depression, or some other type of mental illness you are at higher risk of depression, including depression with atypical features.
Life events
Life events can have a major impact on your mental health. If you experienced abuse or trauma as a child, depression is more likely. Abuse of any kind can cause mental conditions like atypical depression and others. The death of someone close to you can bring on atypical depression. Other stressful life events, including ending a romantic relationship, weight gain, moving, or changing jobs, can increase your chances of depression, too.
Treatments for atypical depression
Fortunately, depression is a highly treatable condition. Atypical depression responds to the same treatments as typical depression does. Talking to a psychiatrist is important if your depression is long-lasting or impairs your daily functioning because you may need medications to recover. A psychotherapist can help you regardless of whether you need medications or not.
Medications
At one time, monoamine oxidase inhibitors (MAOIs) were considered the preferred treatment for atypical depression. However, monoamine oxidase inhibitors (MAOIs) come with difficult side effects. They can cause drowsiness or insomnia. They can also create a life-threatening rise in blood pressure if you eat certain foods, such as pickles, cheese, or red wine. Therefore,
Now, doctors usually prescribe selective serotonin reuptake inhibitors (SSRI’s) medications for atypical depression. Sometimes, tricyclic antidepressants (monoamine oxidase) are used as well. However, for atypical depression, monoamine oxidase inhibitors (MAOIs) have proven to be more effective than tricyclic antidepressants. Since the Diagnositc and Statistical Manual of Mental Disorders (DSM-5) highlights the difference between atypical and clinical depression, further research is needed to compare monoamine oxidase inhibitors (MAOIs) with newer antidepressants such as selective serotonin reuptake inhibitors, for the treatment of atypical depression.
Therapy
With or without medications like selective serotonin reuptake inhibitors, talk therapy is a front-line treatment for atypical features of depression. By talking about your concerns and learning tips and techniques for dealing with atypical depression symptoms, you can improve your condition dramatically. Studies have found that cognitive-behavioral therapy or CBT is particularly effective as a treatment option for atypical depression, especially when combined with other factors such as appropriate medication. Additionally, recent studies have found that online CBT is just as effective as its traditional counterpart for the treatment of a range of depressive conditions.
For people with personality disorders, dialectical behavior therapy can also be helpful. This method includes individual psychotherapy and group skills training to learn mindfulness, distress tolerance, emotional control, and interpersonal effectiveness.
You can talk to a licensed counselor at BetterHelp.com for individual, online therapy on your schedule. Your therapist is there to support you. As you learn how to understand and manage your depression more effectively, you can get back to living a more active, fulfilling life. Through appropriate mental health care, you can enjoy life more consistently and completely.
Takeaway
What is atypical depression characterized by?
Atypical depression refers to a subtype of major depressive disorder (also called major depression) or dysthymic disorder. It is characterized by a distinct set of symptoms and risk factors that differentiate it from typical depression. While only a licensed mental health professional can provide an accurate diagnosis of mental disorders like atypical depression, there are common features associated with this condition:
- Mood reactivity: One notable symptom of atypical depression is "mood reactivity." Individuals with atypical depression can experience an improvement in mood in response to potential positive events or situations. In contrast, those with typical depression often do not experience mood improvement, even in positive circumstances.
- Increased appetite and weight gain: People with atypical depression may have an increased appetite, leading to significant weight gain. In contrast to typical depression, where weight and appetite may decrease, weight gain is a common feature of atypical depression.
- Hypersomnia: Atypical depression is associated with excessive daytime sleepiness and increased total sleep time, known as hypersomnia. In contrast, individuals with typical depression often experience insomnia or disrupted sleep patterns.
- Leaden paralysis: Some individuals with atypical depression describe a feeling of heaviness or "leaden paralysis" in their limbs, which makes daily activities more challenging.
- Rejection sensitivity: People with atypical depression may be particularly sensitive to perceived rejection or criticism from others, which can contribute to their emotional distress.
- Interpersonal challenges: Difficulties in interpersonal relationships, including social withdrawal and avoidance, are common among those with atypical depression.
- Age of onset: Atypical depression often begins at an earlier age than typical depression. Symptoms may emerge during the teenage years or early adulthood.
Depressive symptoms can lead to impaired function and significantly impact an individual's ability to function in daily life, including occupational impairment, social withdrawal, and difficulty maintaining relationships. A comprehensive evaluation of the individual's symptoms, medical history, and risk factors is crucial for determining the most appropriate plan to treat atypical depression, which may include psychotherapy, antidepressant medications, or a combination of both.
Is atypical depression a disability?
Atypical depression, like other forms of depression, is considered a serious medical condition that can significantly impact an individual's daily functioning and overall quality of life. While it is a mental health disorder rather than a physical disability, it is important to recognize that serious mental health conditions, including atypical depression, can have disabling effects on a person's life.
Whether atypical depression qualifies as a disability under legal definitions can vary depending on local laws, controls, and specific circumstances. In many jurisdictions, individuals with mental health conditions like atypical depression may be eligible for disability benefits or accommodations if their condition substantially impairs their ability to work, carry out daily activities, or participate in society.
It's important to note that atypical depression can be a chronic condition, with symptoms lasting for extended periods. These symptoms can include severe mood fluctuations, sleep disturbances, appetite changes, and difficulties in interpersonal relationships. The chronic nature of atypical depression can lead to long-term challenges that affect a person's ability to maintain employment, pursue educational goals, or engage in social activities.
To determine whether atypical depression qualifies as a disability in a specific context, individuals often need to provide medical documentation and undergo a physical exam by healthcare professionals or government agencies responsible for disability assessments. The criteria for disability designation may vary, but they generally consider factors such as the severity of the condition, its impact on daily functioning, and the duration of symptoms.
Individuals with atypical depression or other mental health conditions that significantly affect their lives should consult with their healthcare provider, mental health specialist, or a legal expert familiar with disability guidelines in their jurisdiction. Seeking appropriate treatment and support is essential to managing the challenges posed by atypical depression and improving overall well-being.
What are tips for atypical depression?
Managing atypical depression can be challenging, but there are strategies and treatment options to help control mood and alleviate symptoms:
- Medication: Antidepressant medications may be prescribed to help improve mood and reduce symptoms.
- Psychotherapy: Cognitive-behavioral therapy (CBT), psychodynamic therapy, or interpersonal therapy can be effective in addressing the underlying causes of atypical depression and developing coping strategies.
- Lifestyle changes: Incorporating regular exercise, maintaining a balanced diet, and ensuring sufficient sleep can support overall well-being.
- Social support: Engaging in social activities and maintaining relationships with friends and loved ones can provide emotional comfort and reduce feelings of isolation.
- Stress management: Stress reduction techniques like mindfulness, meditation, or relaxation exercises can help you manage stressors that may exacerbate depressive symptoms.
- Self-care: Self-care activities that promote relaxation and self-compassion can help mitigate symptoms and improve overall well-being.
- Monitor mood: Keeping a mood diary to track changes in mood can help you identify patterns or triggers.
- Avoiding alcohol and substance use: Alcohol and drugs can worsen symptoms of depression, so it's essential to avoid or moderate their use.
Everyone's experience with atypical depression may be different, and what works best can vary from person to person. A combination of approaches may be necessary to manage symptoms effectively.
Is atypical depression ADHD?
Atypical depression and attention deficit hyperactivity disorder (ADHD) are distinct mental health conditions, although they can co-occur in some individuals.
ADHD is a neurodevelopmental disorder primarily characterized by symptoms of inattention, hyperactivity, and impulsivity. While both conditions can affect mood and behavior, they have unique diagnostic criteria and treatment approaches.
Research has shown that individuals with ADHD may experience more hypomanic symptoms during depressive episodes, potentially contributing to the confusion between the two conditions. However, it's crucial to recognize that they are separate diagnoses and a comprehensive evaluation by a mental health professional is necessary to differentiate between them accurately.
What is the drug of choice for atypical depression?
The choice of medication for atypical depression depends on various factors, including the individual's specific diagnosis, symptoms, medical history, and response to previous treatments.
Three classes of antidepressants are commonly considered for atypical depression:
- Selective serotonin reuptake inhibitors (SSRIs): SSRIs such as fluoxetine and sertraline are often considered first-line treatments for depression due to their effectiveness and relatively low risk of side effects. They work by increasing levels of serotonin in the brain.
- Monoamine oxidase inhibitors (MAOIs): In some cases, when SSRIs are ineffective or not well-tolerated, MAOIs may be considered. These medications work by inhibiting the breakdown of serotonin, dopamine, and noradrenaline in the brain. However, they can cause severe side effects and require dietary restrictions. The most commonly prescribed MAOIs are selegiline, isocarboxazid, phenelzine, and tranylcypromine.
- SNRIs (serotonin-norepinephrine reuptake inhibitors): SNRIs like venlafaxine and duloxetine affect both serotonin and noradrenaline levels, making them useful for treating symptoms of atypical depression, such as low energy and motivation. However, they may cause side effects like nausea and increased blood pressure.
The choice between these medications is best determined by a licensed mental health professional who can conduct a thorough assessment, consider the individual's unique circumstances, and tailor the treatment accordingly. It's important to note that antidepressant treatment may require time and adjustments to find the most effective medication and dosage for managing atypical depression. Psychotherapy and lifestyle changes may also be part of the comprehensive treatment plan for this condition.
What is the difference between atypical and regular depression?
There are several key differences between atypical depression and regular depression, also known as major depressive disorder (MDD):
- Symptoms: While both conditions often involve feelings of sadness, hopelessness, or loss of interest in activities once enjoyed, atypical depression is characterized by additional symptoms like increased appetite, weight gain, excessive sleepiness or fatigue, and feeling heavy or leaden in the arms or legs. In contrast, MDD typically involves symptoms like decreased appetite, weight loss, and insomnia.
- Response to treatment: Atypical depression tends to respond better to specific types of antidepressant medications, such as MAOIs, than regular depression. Some individuals with atypical depression may also experience a temporary improvement in symptoms when exposed to positive events or situations. However, recurrence of symptoms is likely in both conditions if treatment is discontinued prematurely.
- Age of onset and duration: Atypical depression often begins at an earlier age, usually in the teenage years, while MDD typically presents later in life. Atypical depression may also have a more chronic course, with symptoms lasting for years or even decades, compared to MDD, which typically involves recurrent episodes of depressive symptoms.
- Risk factors: While both conditions may have similar risk factors like genetics, stress, and trauma, atypical depression has been linked to a higher prevalence of co-occurring mental health conditions, such as bipolar disorder, anxiety disorders, ADHD, and borderline personality disorder.
Does Wellbutrin work for atypical depression?
Wellbutrin is a brand name for the antidepressant bupropion, which is primarily used to treat MDD. Different from SSRIs and MAOIs, this antidepressant inhibits the reuptake of noradrenaline and dopamine. While it's not typically considered a first-line treatment for atypical depression, some research suggests that Wellbutrin may be effective in reducing symptoms of treatment-resistant depression, which can include atypical depression. However, the evidence is limited and inconsistent, and more research is needed to establish its effectiveness in this population.
Is atypical depression bipolar disorder?
Atypical depression and bipolar disorder are two distinct mental health conditions, but they can co-occur in some individuals. Bipolar disorder is a mood disorder that can include episodes of mania or hypomania, which are periods of elevated mood, energy, and impulsivity alternating with periods of depression.
While both atypical depression and bipolar disorder involve symptoms like changes in mood, energy, and behavior, atypical depression is a form of major depressive disorder, whereas bipolar disorder is a separate diagnosis. To differentiate, a mental health professional would consider factors like the duration, frequency, and severity of mood episodes, along with other symptoms and personal history.
Over time, the distinction between these two conditions may become clearer, as bipolar disorder often involves recurrent episodes of mania or hypomania, while atypical depression is more likely to have a chronic and stable course. Treatment approaches for these conditions also differ, with mood stabilizers being the typical treatment for bipolar disorder. However, some medications can be effective in managing symptoms of both conditions, such as certain atypical antipsychotics and MAOIs.
How much disability can you get for depression?
The amount of disability benefits an individual can receive for depression depends on various factors, including the severity and impact of their symptoms on daily functioning. Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) are federal programs that provide financial assistance to individuals with disabilities, including mental health conditions like depression.
To qualify for SSDI, an individual must have a severe, long-term disability that prevents them from working and earning a substantial income. The Social Security Administration (SSA) evaluates the medical evidence to determine an individual's eligibility and level of impairment. Typically, individuals with atypical depression may qualify for SSDI benefits if their condition significantly impairs their ability to work.
SSI is available to individuals with lower incomes who are unable to work due to a disability. Similar to SSDI, the SSA assesses an individual's medical evidence and functional limitations to determine eligibility for SSI benefits. However, the amount of financial support provided by SSI is based on an individual's income and resources.
Both SSDI and SSI also consider other factors like age, education level, and transferable job skills in the evaluation process. Only a licensed professional can determine the extent of an individual's disability and their eligibility for these programs.
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