Overview
Atypical depression used to be considered a form of depression. The American Psychiatric Association no longer recognizes atypical depression as a separate disorder. Instead, the condition is now called major depression with atypical features.
Major depressive disorder (MDD) is a mental disorder that can affect how people think, feel, and behave. People with MDD often lost interest in doing activities they usually enjoy and have trouble performing everyday tasks. Occasionally, they may also feel as if life isn’t worth living. These symptoms may interfere with daily life and take a toll on physical and emotional health.
The symptoms of MDD with atypical features are similar to those of classic MDD. However, there is a key difference. In people who have MDD with atypical features, mood can improve in response to positive circumstances and events. A positive change is unlikely to boost mood in those with classic MDD.
Symptoms
The symptoms of MDD with atypical features can vary from person-to-person. In general, however, those with the condition often experience symptoms of MDD. These symptoms include:
- persistent feelings of sadness or hopelessness
- anxiety or irritability
- sleeping too much or too little
- loss of interest in activities that were once enjoyable
- difficulty concentrating, making decisions, and remembering things
- low energy or fatigue
- thoughts or talk of suicide
They may also experience atypical features of MDD, such as:
- mood that temporarily lifts or brightens in response to positive events or good news
- significant weight gain
- increase in appetite
- heavy feeling in the arms or legs
- body aches or headaches
- sleeping for extended periods of time during the day or night
- extreme negative response to perceived criticism or rejection
Causes
The reason why some people experience atypical depression is not known. A potential cause of atypical depression is an imbalance in certain neurotransmitters, including dopamine, serotonin, and norepinephrine, which all influence mood.
Other factors that can raise your risk for atypical depression include:
- Family history. You are more likely to experience symptoms of atypical depression if others in your family also have depression or another type of mood disorder.
- Certain medical conditions. You may be more likely to experience atypical depression if you have a history of bipolar disorders, anxiety disorders, avoidant personalities, body dysmorphic disorder, or social phobia.
- Substance use. Having a history of substance use can also increase the likelihood of depression.
Risk factors
Risk factors for atypical depression may include:
- History of bipolar disorder
- Misuse of alcohol or recreational drugs
- Traumatic childhood experiences
- Environmental stressors
Your risk of atypical depression may also increase if you have:
- Blood relatives with a history of depression, bipolar disorder or alcoholism
- Stressful life events, such as the death of a loved one
Diagnosis
Schedule an appointment with your doctor if you believe you have MDD with atypical features. Your doctor may complete a physical examination and order lab tests, such as a complete blood count and a thyroid function test. These tests can check for potential health problems that may be triggering your symptoms. Treating an underlying illness may improve your mood and ease other symptoms associated with MDD.
Your doctor may also complete a psychological evaluation to look for signs of MDD with atypical features. They may ask you questions about your:
- symptoms
- personal life
- past experiences
- current medications
- personal or family history
Your doctor may diagnose MDD with atypical features if:
- there is no underlying condition causing your symptoms
- your symptoms match the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
When to see a doctor
If you feel depressed, make an appointment to see your doctor as soon as you can. Atypical depression may get worse if it isn’t treated. If you’re reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.
Treatment
Treatment for MDD with atypical features can vary. In most cases, however, treatment includes a combination of medications, talk therapy, and lifestyle changes.
Medications
Your doctor may prescribe antidepressants, such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs). Some people who have MDD with atypical features don’t respond well to tricyclic antidepressants. However, numerous MAOIs and SSRIs have proven effective in treating symptoms of the disorder. Your doctor may prescribe one medication or a combination of medications to control your symptoms.
It’s important to note that taking an MAOI may require changing your diet. These antidepressants can interact with certain foods and medications, including birth control pills and decongestants. Make sure to ask your doctor about side effects and food or drug interactions before you begin taking a new medication.
Talk Therapy
Talk therapy involves meeting with a therapist or counselor on a regular basis. This type of treatment allows you to:
- express your feelings
- identify unhealthy thoughts
- learn how to problem solve
This can help you cope with your condition and improve your outlook. Your therapist can also show you how to set realistic life goals so you can regain a sense of satisfaction and control over your life.
Lifestyle and Home Remedies
Aside from medication and therapy, lifestyle changes and home remedies may also help relieve symptoms of MDD with atypical features. These include:
- avoiding recreational drugs and alcohol
- exercising at least three times per week
- getting plenty of sleep
- implementing relaxation techniques, such as deep breathing and meditation
- taking certain supplements, such as fish oil and St. John’s wort
Make sure to consult with your doctor before you start taking any supplements. Some natural remedies may interact with certain medications used to treat MDD.
Living with Atypical Depression
If atypical depression is interfering with your daily activities, working with your doctor to develop a treatment plan that involves medication and psychotherapy is a great first step. Beyond that, there are lifestyle modifications that may help ease the symptoms and help you better cope.
- Prioritize nutrition and exercise. Doing your best to stick with a healthful diet and regular exercise program will improve your overall health and help decrease the symptoms of atypical depression. Aim to exercise five days a week, for 30–60 minutes a day.
- Practice mindfulness meditation and deep breathing. Deep breathing exercises combined with mindfulness medication can teach you to become aware of your thoughts and feelings without reacting to them.
- Write in a journal. Journaling, or expressive writing, is a highly recommended tool for dealing with depression. Whether you do it daily or weekly, making journaling a habit can help allow you to explore your feelings and counteract many of the negative effects of stress.
- Seek support. Perhaps the most important thing you can do to cope with depression and prevent isolation is to develop strong social support. This can include trusted family and friends or an online or in-person depression support group with whom you can connect with and share your feelings and experiences.
Prevention
There’s no sure way to prevent atypical depression, but these strategies may help.
- Take steps to control stress, to increase your resilience and to boost your self-esteem.
- Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
- Get treatment at the earliest sign of a problem to help prevent depression from worsening.
- Consider long-term maintenance treatment to help prevent a relapse of symptoms.
- Depressive disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed July 13, 2018.
- Lojko D, et al. Atypical depression: Current perspectives. Neuropsychiatric Disease and Treatment. 2017;13:2447.
- Lyness JM. Unipolar depression in adults: Clinical features. https://www.uptodate.com/contents/search. Accessed July 13, 2018.
- Depression. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/depression/index.shtml#part_145399. Accessed July 13, 2018.
- Depression. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/Depression/Overview. Accessed July 13, 2018.
- Lojko D, et al. Atypical features in depression: Association with obesity and bipolar disorder. Journal of Affective Disorders. 2015;185:76.
- Stress and relaxation techniques: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/relaxation-science. Accessed July 13, 2018.
- Milaneschi Y, et al. Genetic association of major depression with atypical features and obesity-related immunometabolic dysregulations. JAMA Psychiatry. 2017;74:1214.
- What is depression? American Psychiatric Association. https://www.psychiatry.org/patients-families/depression/what-is-depression. Accessed July 16, 2018.
- Depression and complementary health approaches: What the science says. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/providers/digest/depression-science. Accessed July 16, 2018.
- Haynes PL, et al. Social rhythm therapies for mood disorders: An update. Current Psychiatric Report. 2016;18:75.
- Using dietary supplements wisely. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/supplements/wiseuse.htm. Accessed July 16, 2018.
- Peer support. Depression and Bipolar Support Alliance. https://secure2.convio.net/dabsa/site/SPageServer/?pagename=peer_landing. Accessed July 16, 2018.
- Find support. National Alliance on Mental Illness. https://www.nami.org/Find-Support. Accessed July 16, 2018.
- Get help. National Suicide Prevention Lifeline. https://suicidepreventionlifeline.org/. Accessed July 18, 2018.
- The road to resilience. American Psychological Association. http://www.apa.org/helpcenter/road-resilience.aspx. Accessed July 16, 2018.
- Hirsch M, et al. Monoamine oxidase inhibitors (MAOIs) for treating depressed adults. https://www.uptodate.com/contents/search. Accessed July 18, 2018.
- Nardil (prescribing information). New York, N.Y.: Pfizer; 2007. https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011909s038lbl.pdf. Accessed July 18, 2018.
- Important information to know: Monoamine oxidase inhibitor (MAOI) medications. https://www.cc.nih.gov/ccc/patient_education/drug_nutrient/maoi1.pdf. Accessed July 18, 2018.
