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What is Atypical Depression?

Depression is a heterogeneous illness characterized by multiple pathways which cause it. Various therapeutic agents are used to treat it. It is a spectrum of disorders, which sometimes overlap. They range from bipolar depression to major depressive disorder. The most common in the spectrum are atypical and melancholic subtypes of depression.

Atypical depression is defined, according to the Diagnostic and Statistical Manual of Mental Disorders V (DSM-5), as depression which has symptoms much like major depressive disorder but is distinguished from them by several “atypical” presentations, such as improved mood in response to positive events in the person’s environment. This is not the case for melancholic depression where positive response to similar pleasurable events is absent.

Atypical depression is classified differently. This influences how it is treated, and the extent of its severity. It was also noted, during its discovery, to have different or “unique” symptoms compared to the earlier discovered melancholic depression. It also had a different response to the medical treatment, i.e., anti-depressants, which were offered at the tim.

People with atypical depression tend to be younger at the onset of the illness. It usually runs a long and severe course of recurrent episodes throughout the lifetime of the people who are affected. It has been associated with the female gender and with unhealthy behaviors/habits e.g., smoking, social isolation, low physical activity, obesity, heart disease, and even higher rates of comorbid psychiatric disorders. There is also a predisposition to this form of depression among adults who have a history of depression in their teenage years, as well as a link to bipolar disorders.

How do I identify atypical depression?

Since it is a subtype of major depressive disorders, you have to meet the criteria for diagnosis of the same, according to the Diagnostic and Statistical Manual of Mental Disorders, before specifying the symptoms of atypical depression. The symptoms must be present fairly consistently for at least two weeks to be defined as a major depressive disorder, with the exception of weight change and suicidal ideation.

The symptoms of depressive disorders are:

  • A depressed mood present most of the day almost every day. This may present as irritability in children and adolescents.
  • Loss of interest or pleasure in things which were previously enjoyable
  • Major change in weight: in atypical depression, this presents as an increased appetite with weight gain
  • Sleep disturbances: presenting as hypersomnia (excessive sleep) in atypical depression
  • Feeling hopeless and/or worthless accompanied by a strong sense of guilt
  • Mood reactivity to immediate environmental circumstances
  • Fatigue or loss of energy for most of the day
  • Interpersonal rejection sensitivity: excessive response leading to social and occupational impairment
  • Leaden paralysis: the feeling of the limbs being weighed down
  • Difficulty thinking, concentrating and/or making decisions
  • Suicidal ideation

For an experience to be accurately termed as a major depressive episode, the person should have had at least five of the above symptoms with clinically significant distress and/or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be associated with substance use/abuse, medial conditions, or bereavement.

Some might experience milder episodes, in which case the person’s functions may seem normal although they now require much more effort. There are other observable changes which may be identified by observing the person e.g., their tone of voice, their facial expressions, and general demeanor. Some might even complain of physical manifestations such as body aches and pains.

What causes atypical depression?

Depression is believed to be the result of the interaction of a host of factors including genetic, biological, environmental, and individual factors. These factors interact in a complex manner. The part of the brain which regulates mood is usually affected by the circuits which transmit brain chemicals (known as neurotransmitters)¬¬ such as serotonin, dopamine, and norepinephrine.

Risk factors for the development of depression include:

  • Family history of depression
  • A significant event which may trigger an underlying propensity to depression e.g., the death of a loved one, a divorce, etc.
  • Interpersonal conflicts
  • Physical, emotional, or sexual abuse
  • A major life event such as moving to a different area, changing jobs or losing a job, graduating, retiring, etc.
  • Drug or alcohol abuse

Is it treatable?

Yes, it is! It has been shown individuals who suffer from this kind of depression respond well to the available medical treatment combined with psychotherapy (talk therapy) from a qualified specialist psychiatrist or psychologist. The medical treatment includes the use of antidepressants like citalopram.


In summary, atypical depression is a subtype of depression which stands out from the classical description of depression by its symptomatology i.e., hypersomnia, leaden paralysis, increase in appetite, and weight gain to name a few. It has a relatively early onset (affecting teenagers) and is associated with unhealthy behaviors like smoking. Its causation is complex, involving the interaction of several factors, but it does have identifiable risk factors. It responds well to treatment, and people who are affected with it are encouraged to seek it out.

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