Atypical depression is a subtype of major depressive disorder. It is distinct from melancholic depression, which primarily causes sadness even in the face of hopeful circumstances and positive events. Atypical depression, by contrast, means that a person’s mood may improve when circumstances change.
Some people may use the term atypical depression to refer to depression that is inconsistent with depression stereotypes, or common manifestations of depression. This is a misuse of the term. Atypical depression is a specific subtype of depression with specific diagnostic criteria.
Treatment is similar to other forms of depression, but atypical depression may sometimes respond better to a group of antidepressants called monoamine oxidase inhibitors (MAOI).
Keep reading to learn more about atypical depression, including the symptoms, causes, and tips on living with this condition.
Atypical depression is distinct from melancholic depression. Melancholic depression is the form of depression that most people might identify as depression. It includes a very sad mood and trouble finding pleasure.
Atypical depression can also make people deeply sad. But unlike with melancholic depression, symptoms may improve in response to positive life events or hope for the future. In this regard, atypical depression is more tied to a person’s situation and environment.
Some other features of atypical depression include:
- It tends to be more chronic.
- It is more prevalent in women.
- It often causes excessive eating or weight gain.
- It may cause a person to feel very sluggish or sleepy.
- It can cause a person to feel heavy in the arms and legs.
People with atypical depression have major depressive disorder (depression). A hallmark of major depressive disorder is feeling sad, hopeless, or overwhelmed. The more traditional presentation of major depressive disorder is melancholic, which causes a person to struggle to feel joy or pleasure, even in pleasurable circumstances.
With atypical depression, the course of the disease is more likely to change and shift. Symptoms may improve with improved circumstances, or worsen with worsening life circumstances. That said, people with atypical depression are more likely to have recurring bouts of the disease. So even once a person feels better for a period, their symptoms may return.
Some hallmarks of atypical depression include:
- excessive sleeping
- feeling slow or sluggish
- feeling like the arms or legs are heavy
- eating too much or gaining excessive weight
- symptoms that may improve when a person has something to feel happy about
Atypical depression is not a different diagnosis from melancholic depression. Rather, both are subtypes of major depression, and share many symptoms. Some other symptoms a person might notice in both types of depression
- feelings of guilt or worthlessness
- feeling hopeless
- struggling to find motivation
- physical symptoms such as pain or headaches
- unusual food cravings
- changes in energy level
- thoughts of suicide or self-harm
- relationship difficulties stemming from depression symptoms
Researchers frequently apply a biopsychosocial model to depression, which means that there is no single cause. Instead, a complex interaction of environment, genetics, social factors, interpersonal factors, health, and more interact to cause depression.
- family history of depression
- major life changes
- chronic stress
- serious health issues
- biological changes, such as giving birth or going through menopause
A 2019 study of atypical depression found the following characteristics were more prevalent in people with this form of depression:
- an earlier age of depression onset
- recurring and more severe depression episodes
- unhealthy behaviors
- female sex
- more adversity in life
- higher rates of certain illnesses, including cardiovascular disease and metabolic syndrome
No single test can determine depression. Doctors diagnose depression based on symptoms.
In some cases, a doctor may want to exclude other potential causes of symptoms, especially in people who are at high risk for other diseases. For example,
If a doctor suspects a person may have another condition, they may recommend bloodwork or other tests. In most cases, however, a professional will diagnose depression based solely on symptoms. To get an accurate diagnosis, it is important for a person to tell their doctor or mental health specialist about all symptoms they experience.
The diagnostic criteria for atypical depression include:
- Mood reactivity: This means that a person’s mood improves in response to perceived or potential positive events.
- Lack of melancholic features: This means a person does not have symptoms of melancholic depression, which include difficulty gaining pleasure from pleasurable events.
- Two or more of the following:
- high rejection sensitivity
- excessive sleepiness
- excessive eating or weight gain
- a heavy feeling in the arms or legs
The mainstay of treatment for depression is a combination of psychotherapy and antidepressants. Psychotherapy can help a person process their emotions, feel less isolated, and develop strategies for dealing with depressing thoughts. For example, in cognitive behavioral therapy, a person will learn how their thoughts influence their emotions and behavior.
A range of antidepressants may help with atypical depression. However, most research suggests that a group of drugs called monoamine oxidase inhibitors (MAOIs) may be more effective than newer selective serotonin reuptake inhibitors (SSRIs). Consider asking a doctor about trying an MAOI first.
MAOIs make it difficult for the body to break down a substance called tyramine. Rarely, this failure to break down tyramine can cause brain damage and death. Ask a doctor about which foods to avoid. In general, fish, meat, liver, and salami have higher levels of tyramine, especially when they are not fresh.
Atypical depression tends to relapse. This means that a person may need to undergo treatment throughout their life, and develop a depression relapse plan. Some strategies for living with atypical depression are below:
- Be mindful of depression triggers: This can help a person treat depression early in its course.
- Be mindful of strategies that help with depression: Some people find relief from exercise, time with loved ones, hobbies, following a schedule, and pleasurable activities like reading.
- Develop a relationship with a trusted therapist: If a relapse occurs, they can help manage symptoms.
- Tend to physical as well as mental health: Strive for a balanced diet, plenty of sleep, and regular exercise.
- Ask for help and support from loved ones: In some cases, loved ones might notice that a person is having a relapse even before the person with depression notices.
Depression is a complex illness that can manifest in many different ways. Symptoms may change over time even in the same person in the same circumstances.
Atypical depression is highly situational, which means a person’s symptoms may improve in the right environment, or temporarily appear to be better when their external circumstances are happy. As circumstances change, so too may depression symptoms.
Depression is not something a person can think their way out of. It is a medical diagnosis that causes changes in the brain. The right treatment can help counteract these changes, reducing symptoms and improving overall quality of life.
People who think they may have depression should ask for help, and consider seeking care until they find treatment that works.