Atypical depression: causes, symptoms, and treatments

Atypical depression is a type of depression wherein the symptoms stray from the standard criteria. People with this unique variant of depressive disorder experience typical symptoms of depression but exhibit improved mood in response to positive events.

Causes of atypical depression are complex and multifaceted but tend to involve a combination of a family history of depression, a significant loss (death, divorce, separation), interpersonal conflicts, and related emotions such as guilt, abuse (physical, sexual, emotional), major life event, any type of serious illness and drug or alcohol abuse.

Symptoms of atypical depression include sleeping too much (hypersomnia), increased appetite or weight gain, having more intense reactions or increased sensitivity, and a feeling of being weighed down, paralyzed, or leaden. 

Treatment options for atypical depression include psychotherapy, medication, and lifestyle changes. Early recognition and diagnosis can help improve treatment outcomes for people with this disorder.

What is atypical depression?

Atypical depression is a depressive state and a separate diagnosis of major depressive disorder (MDD). Atypical depression is defined as a subtype of depression. Those affected exhibit a distinct set of symptoms that differ from MDD. 

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) by the American Psychiatric Association categorizes atypical depression as a major depressive disorder with atypical features. In DSM-5, atypical depression belongs to a group of mood disorders just like MDD in general.

Researchers West and Dally first introduced the term “atypical depression” in 1959 to describe a state that responds well to monoamine oxidase inhibitors (MAOIs), stated Jonathan R T Davidson in a paper titled A History of the Concept of Atypical Depression published in 2007 in the Journal of Clinical Psychiatry. Over the years, the concept of atypical has evolved and its diagnostic criteria have changed. That happened because atypical depression was described in several ways. For example, melancholia (endogenous depression), phobic anxiety with secondary depression, vegetative reversal (oversleeping and overeating), intense emotional pain from rejection (rejection sensitivity), and depression with severe chronic pain. There is no consistent pattern in these portrayals, and it is difficult to define a single type of depression as “atypical”. The Columbia criteria (or DSM-IV), which demonstrates the effectiveness of MAOI drugs over tricyclics, has become widely accepted. 

In order to address the widespread occurrence and impact of depression, the Agency for Health Care Policy and Research (AHCPR) formed a panel of experts to create treatment guidelines for depressive illness, reported Frederic M. Quitkin, M.D. in his paper, published in the March 2002 issue of the Primary Care Companion to the Journal of Clinical Psychiatry. The panel aimed to encourage primary care physicians to provide a first line of treatment to patients with depression. But, the AHCPR guidelines from 1993 didn’t specifically address depression with atypical features. 

A year later, the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), added atypical features. This helped differentiate the different subtypes of depression within the larger diagnosis of depressive illness. 

Based on the results, depression with atypical features can be difficult to diagnose because some of its aspects such as its chronic course and onset in adolescence are not typical symptoms of a mood disorder. Because of this, patients were often misdiagnosed with other conditions like neurotic or characterologic depression. 

However, medical experts now have a better understanding of depression with atypical features, including new genetic and epidemiological data that support its validity as a diagnostic category. With the arrival of DSM-5 in 2013, the understanding of atypical depression increased but this mental illness requires further research.

How common is atypical depression?

Atypical depression is the most frequently occurring form of depression in psychiatric outpatient clinics. About 40% of people with major depressive disorder or dysthymia meet the criteria for atypical depression as defined in DSM-IV. 

This depressive state is 4 times more common in women than in men, according to the abovementioned paper from Psychiatry (Edgmont). Hormonal differences and body image concerns may have a role to play. A woman experiences a lot more hormonal fluctuations throughout her life compared to men, especially during periods of menstruation, pregnancy, and menopause. Women are often more worried about their body image and overall appearance, which can lead to low-self esteem and symptoms of atypical depression.

Recent statistics that use the DSM criteria suggest that 15% to 29% of depressed patients have atypical depression. There is a prevalence of 18% to 36%, explains Dorota Łojko in her paper from the September 2017 issue of Neuropsychiatric Disease and Treatment journal. Some potential reasons for this prevalence are neurochemical imbalances, hormonal factors, genetic predisposition, and stressful life events. 

A research paper published by Xin Li-Min and colleagues in the March 2019 issue of the Journal of Affective Disorders found that atypical depression is common in people with major depressive disorder (MDD). The study recruited 1,172 patients with MDD. Based on the results, there was a 15.3% prevalence rate of atypical depression. MDD with atypical features can be more severe and debilitating than MDD with non-atypical features. This can have a profound impact on the patient’s mental state and quality of life. 

What are the causes of atypical depression?

The causes of atypical depression are complex and multifaceted. The exact cause is unknown, but it could involve a combination of psychosocial, environmental, and genetic factors. Common causes of atypical depression are listed below:

• A family history of depression
• A significant loss – from death, divorce, or separation
• Interpersonal conflicts and related emotions such as guilt
• Any type of abuse – physical, sexual, or emotional
• Any type of major life event
• Any type of serious illness 
• Drug or alcohol abuse

1. A family history of depression

A family history of depression is a record of depression and a pattern of mental illness that affects multiple generations within a family, or parents and siblings. Family history plays a role in the development of mental and physical conditions alike, and it is also the cause of atypical depression.  

A family history of depression becomes a cause of atypical depression because people may have a genetic predisposition to develop this mental illness. Research by Rybakowski JK and Lojko D. published in the September 2017 issue of Neuropsychiatric Disease and Treatment shows that having a first-degree relative with depression increases the risk of developing atypical depression. Certain genes or gene variations can affect brain chemistry and functioning. When someone has a first-degree relative (such as a parent or a sibling) with depression, they are more likely to inherit various genetic factors. 

Several genes have been implicated in the development of atypical depression and mood reactivity. One of them is the SLC6A4 gene, which is involved in the regulation of serotonin levels in the brain. Serotonin is a neurotransmitter that is involved in regulating mood. Imbalances in serotonin levels can lead to the development of depression, explain Simon Sanwald et al. in their research article from the March 2021 issue of BMC Psychiatry. Variations in the SLC6A4 gene might increase the risk of atypical depression. 

Another gene linked with atypical depression is the MAOA gene. This gene is involved in the regulation of dopamine, a neurotransmitter that regulates mood, motivation, and reward. Any imbalances in dopamine levels might lead to depression, stated P.A. Melas et al. in an article from the August 2013 issue of International Journal of Neuropsychopharmacology. Variations in this gene can increase the likelihood of atypical depression. Dysregulated DNA methylation programming of MAOA may also contribute to the development of depression. The DNA methylation status of NR3C1, known as a neurobiological sign of early-life trauma, was elevated in individuals who lost a parent at a very young age. Additionally, this study suggested that the methylation of NR3C1 could be influenced by genetic variants of MAOA.

A family history of depression is one of the causes of atypical depression because it can be a learned behavior. A child who grows up in a household where a parent or sibling has depression may learn to mimic that person’s behavior under certain conditions. For example, they may not think it’s unusual to spend all day in bed without interest to engage in activities or do something.

2. A significant loss — from death, divorce, or separation

A significant loss – from death, divorce, or separation is the emotional suffering caused by absence of a beloved person from one’s life. This absence can be due to their death or it results from any kind of separation whether it’s divorce or moving far away. Significant loss, whether it’s from death, divorce, or separation, can cause a range of emotions that can lead to atypical depression. 

A significant loss – from death, divorce, or separation becomes a cause of atypical depression because it can lead to changes in their brain chemistry. It can change the levels of certain neurotransmitters in the brain, such as serotonin and norepinephrine, which can lead to symptoms of depression.

One of the main regions of the brain that’s affected by grief and loss is the prefrontal cortex. This region is responsible for executive functioning, which includes decision-making, planning, and impulse control. Significant loss can lead to decreased activity in the prefrontal cortex. This can make it difficult for the patient to plan or make decisions, and increase their impulsivity.

The amygdala is also affected by grief and loss, explains Gang Chen, PhD, et al. in a study from the October 2020 issue of The American Journal of Geriatric Psychiatry. Significant loss can increase the activity in the amygdala, thus increasing the levels of anxiety and fear. 

In a LiveScience article, Dr. Lisa M. Shulman, a neurologist, and director of the University of Maryland’s Movement Disorders Center, explained there is no standalone event when it comes to grief and sadness. The brain is working overtime to try and cope with the sadness. But, when patients are dealing with significant loss, they summon a psychological defense mechanism. So, there will be days, weeks, and months that are filled with reminders and triggers. 

Grief can also lead to changes in the hippocampus, reported Kathryn Sawyer, Ph.D. et al. in a study issued in June 2012 in  Aging and Mental Health journal. This area of the brain is involved in memory processing. These reports have shown that grief can result in a decrease in the volume of the hippocampus and can lead to difficulties with memory and learning.

A significant loss – from death, divorce, or separation is one of the causes of atypical depression because it can cause changes in a person’s social support networks, which can also contribute to the development of atypical depression. When we lose someone we love, it can lead to feelings of isolation and loneliness. This can make it more difficult to cope with the loss. As a result, many patients with atypical depression develop a vicious cycle, where the individual withdraws from social situations, leading to further isolation and worsening depression symptoms.

3. Interpersonal conflicts and related emotions such as guilt

Interpersonal conflicts and related emotions such as guilt represent any kind of conflict or disagreement between two or more people and feelings that are direct consequences of these problems. Conflicts between people occur due to a wide range of reasons including lack of trust or problems in relationships. They can lead to even bigger issues such as divorce or losing a friend, but may also contribute to mental illnesses such as atypical depression.

Interpersonal conflicts and related emotions such as guilt become a cause of atypical depression because they can be overwhelming and cause emotional and behavioral changes. Guilt they feel and being overwhelmed make them feel inadequate. People with a guilt complex often find themselves living a life where they constantly try to “make up” for their disappointment.  

Different interpersonal conflicts, relationship conflict, school-related conflicts, and parental conflict can contribute to the development of atypical depression. According to reports by Daniel J. Weigel and M. Rosie Shrout issued in March 2021 in Personality and Individual Differences, depression can make conflicts worse for couples. That’s because depressed partners are more likely to use destructive tactics and less constructive communication strategies to try and resolve an argument. This can lead to a cycle of negative interactions and poor conflict resolution between partners. Depressed partners tend to blame, criticize, and attack each other, which can further escalate a conflict. This can be harmful to the relationship and lead to feelings of quit, helplessness, and hopelessness. 

Interpersonal conflicts and related emotions such as guilt are one of the causes of atypical depression because that individuals with atypical depression often experience a greater degree of sensitivity to interpersonal rejection and criticism than those with other forms of depression, according to a study Characteristics of Bipolar II Patients with Interpersonal Rejection Sensitivity by Franco Benazzi MD published in the December 2001 issue of Psychiatry and Clinical Neurosciences.

4. Any type of abuse — physical, sexual, or emotional

Any type of abuse – physical, sexual, or emotional is defined as an action that intentionally harms another individual. The harm can be physical, sexual, or emotional and it takes its toll on a person’s mental health. A history of abuse can contribute to the development of many mental illnesses including atypical depression. 

Any type of abuse – physical, sexual, or emotional becomes a cause of atypical depression because it is a traumatic experience that leads to changes in a person’s brain. According to a comparative study by Amy C Withers et al. published in the May 2013 issue of the Journal of Clinical Psychiatry, there is a connection between atypical depression and lifetime trauma. The connection is complicated, involving multiple factors such as environmental, genetic, and psychological factors. Trauma can force the brain to stay in a state of hypervigilance. It can suppress the patient’s memory and impulse control and trap the patient in a constant state of powerful emotional reactivity. 

In people with atypical depression, emotional reactivity is often heightened. The sensitivity to rejection and criticism is linked to changes in the brain’s reward system and emotional processing centers. 

Research by Marieke J. H. Begemann et al. published in the June 2021 issue of Psychological Medicine suggests that childhood trauma can cause physical changes in the brain, specifically the frontal lobe. These changes can result in a decrease in the volume of gray matter in that region. Childhood trauma can affect brain development and result in a range of psychological and behavioral problems, including anxiety, depression, and post-traumatic stress disorder (PTSD). The reduction of gray matter volume in the frontal lobe can lead to difficulties with emotional regulation, decision-making, and other cognitive processes. This can contribute to the development of mental health disorders such as atypical depression. 

Any type of abuse – physical, sexual, or emotional is one of the causes of atypical depression due to the inability to process emotions properly. When someone struggles to manage their emotional responses, they can develop a cycle of negative emotions and stress that can exacerbate the symptoms of depression. It can interfere with their ability to engage in healthy coping behaviors, such as exercise or seeking social support. The relationship between trauma and atypical depression may be interrelated throughout a person’s life rather than being a direct cause-and-effect. This means that there are ongoing impacts of trauma that contribute to the development of atypical depression.

5. Any type of major life event 

Any type of major life event is a significant change or transition that occurs in a person’s life. This event is often very disruptive and stressful. It causes a heavy emotional toll and requires people to adapt to new circumstances. The most common major life events that can impact a person’s mental health include moving to a new city or country, retirement, bankruptcy or job loss, legal troubles, such as arrest or imprisonment, the birth of a child, etc. These events can affect a person’s psychological well-being and contribute to the development of atypical depression.

Any type of major life event becomes a cause of atypical depression because it may take away predictability and control in a person’s life and increase stress levels. For example, losing a job can trigger a powerful sense of uncertainty about the future. It can also create financial stress and lead to feelings of anxiety and depression. Furthermore, major life events can also trigger a range of physical and emotional symptoms, such as changes in appetite and oversleeping. These symptoms are often associated with atypical depression. 

According to Kate Stroud, PhD, and her research published in 2010 by the Family Institute at Northwestern University, around 70% of first depression episodes and 40% of recurrent episodes of depression occur due to a severely stressful life event. Experts found that 80% of depressed patients had a prior severe stressful life event. Any event that is too stressful can have a neurobiological impact. Chronic activation of the stress response can dysregulate various neurotransmitters, like serotonin and norepinephrine. These neurobiological changes can contribute to depression. 

Stressful life events can also make depressive symptoms worse and lead to major depression in both adults and teenagers. During the depression, the role of stress changes with time. The stress sensitization theory suggests that the first episode of depression makes a person more sensitive to stress. It leaves an emotional scar, explains Benjamin G. Shapero and his team in the paper published in the March 2014 issue of Journal of Clinical Psychology. This means that future episodes require less stress to trigger depressive symptoms again. This explains why depression can come back often and quickly. 

Any type of major life event is one of the causes of atypical depression due to a significant impact on a person’s level of optimism. In the face of stress and adversity, it can be difficult to maintain a positive outlook and hope for the future. A Heinz Nixdorf Recall study carried out by Janine Gronewold et al. in the July 2022 issue of PloS One, found that people who experience severely stressful life events are more likely to develop negative and pessimistic thinking patterns. This can lead to feelings of hopelessness and contribute to the development of atypical depression. Optimism is a stable personality trait. It helps people maintain stable mental health and well-being. People who are optimistic can cope better with stress and maintain a sense of control over their lives. 

6. Any type of serious illness

Any type of serious illness refers to a health condition that carries a high risk of mortality and/or has a profound impact on a person’s health and well-being. It can lead to a cascade of physical and psychological challenges that are difficult to navigate. These illnesses often require intensive medical care and can have a long-lasting effect on the patient’s quality of life. Serious illnesses can range from chronic conditions such as diabetes and heart disease to life-threatening ailments such as cancer and HIV/AIDS. A serious illness can contribute to the development of atypical depression.

Any type of serious illness becomes a cause of atypical depression because it carries a tremendous emotional burden. As a result, a person experiences a range of intense emotions, such as despair, anxiety, fear, isolation, and hopelessness. Because of the long-term nature, many people with chronic diseases are prone to depression. 

Reports from Ying Ma et al. published in the September 2021 issue of BMC Psychiatry estimate there is a 9.3% to 25% prevalence of depression in people with chronic diseases. The most commonly recorded diseases include coronary heart disease, hypertension, and diabetes. A serious illness can lead to atypical depression in several ways. The physical symptoms of the illness can lead to feelings of discomfort, pain, and residual fatigue. These symptoms can make it difficult for people to engage in daily activities. This can result in a loss of interest in activities that were once enjoyable. Since a serious illness is difficult to cope with, it can cause anxiety and fear about the future and overall health. 

Any type of serious illness is one of the causes of atypical depression because it forces a person to change their life. People with serious illnesses often lose their independence or are forced to make significant changes in daily life, which lead to despair and sadness. A person in such a situation is prone to depressive symptoms. This is particularly the case when disease changes how they see themselves or relate to others e.g. friends or family. A drastic change in lifestyle can be difficult to navigate and thereby contributes to atypical depression.

7. Drug or alcohol abuse

Drug and alcohol abuse refers to the excessive use of substances such as alcohol, illegal use of illicit drugs, and the use of prescription or over-the-counter medications for purposes they aren’t intended for. It can wreak havoc on a person’s mental and physical health. Substance abuse can manifest in different ways such as using illegal drugs, misusing prescription medications, or consuming excessive amounts of alcohol. The impact of physical addiction can be far-reaching. They can affect a person’s family, friends, and career. Drug and alcohol abuse can also contribute to the development of atypical depression.

Drug and alcohol abuse becomes a cause of atypical depression because it alters the chemical balance in the brain. Substance abuse can contribute to atypical depression in several ways, explains Adam M. Leventhal and his colleagues in a paper from the October 2008 issue of Psychiatry Research journal. These substances force the brain to create, absorb, or transmit less dopamine. When the substances leave the system, dopamine levels plummet. As a result, people can experience potent cravings and withdrawal issues. This can lead to a change in mood, behavior, and thought patterns. These changes can trigger or worsen symptoms of depression, including those associated with atypical depression. Also, substance abuse can exacerbate the physical symptoms of atypical depression such as fatigue and weight gain. This can further perpetuate the cycle of self-medication and worsen overall health. For example, alcohol is high in calories and can lead to further weight gain. This can worsen feelings of low self-esteem in people with atypical depression. According to research by J. Glaus et al. published in the October 2013 issue of Acta Psychiatrica Scandinavica journal, atypical depression with alcohol misuse can increase the risk of developing heart problems.

Drug and alcohol abuse is one of the causes of atypical depression as it causes physical health problems that contribute to depressive symptoms. Substance abuse can cause damage to major organs, disrupt sleep patterns, and impair cognitive function. The resulting emotional and physical distress can increase the odds of developing atypical depression.

Who is at risk for atypical depression?

Although anyone can develop atypical depression, some risk factors increase the odds of its occurrence. Atypical depression is more common in depressed younger people than in older adults. Based on reports from Natalie Sachs-Ericsson, Ph.D et al. from the July 2012 issue of the American Journal of Geriatric Psychiatry, 25% to 40% of young people with depression have atypical depression. 

There are several reasons why youth can be more prone to this sub-type of depression. The younger generation is more likely to experience trauma and stress during critical developmental periods. For example, they have higher odds of experiencing bullying at school. They are also more likely to engage in high-risk behaviors, such as drug and alcohol abuse. 

Furthermore, young people are still figuring out their identity and place in the world. This period of transition can be challenging and stressful, especially when paired with negative thoughts and low self-esteem. When these feelings are not addressed, it can lead to atypical depression 

Another significant risk factor is a family history of depression. If a close family member has depression, like the parent, then the child can be at risk of developing atypical depression. Significant life stressors, such as divorce, separation, or serious diseases can make a person more prone to atypical depression. In addition, people with a history of physical, sexual, and emotional abuse are at a higher risk. Understanding these risk factors can help people recognize the signs and seek adequate atypical depression treatment.

What are the symptoms of atypical depression?

Atypical depression is a depressive state with a range of symptoms. This depressive state can cause strong feelings of guilt, decreased appetite, and feeling laden. The review The Modern Concept of Atypical Depression: Four Definitions by Susumu Ohmae from the January 2010 issue of the Japanese journal Seishin Shinkeigaku Zasshi, classified the symptomatic features of this disorder into two subtypes: Type A and Type V. Type A mainly includes anxiety symptoms, while type V includes atypical vegetative symptoms, such as weight gain and oversleeping. Since atypical depression is a mild and chronic subtype of depression, people can share both symptomatic subtypes. The most notable symptoms of atypical depression are listed below:

• Sleeping too much (hypersomnia)
• Increased appetite or weight gain
• Having a more intense reaction or increased sensitivity
• Having a feeling of being weighed down, paralyzed, or “leaden”

1. Sleeping too much (hypersomnia)

Hypersomnia is a state of excessive sleepiness. It is the inability to stay awake during the day despite getting more than enough sleep the night before. Hypersomnia is a condition that can have a significant impact on a person’s quality of life. This condition increases the risk of work-related injury and reduces workplace productivity. Hypersomnia occurs due to other sleep disorders such as insomnia or sleep apnea, medical conditions, drug abuse, and it can also be a symptom of atypical depression.

Hypersomnia becomes a symptom of atypical depression due to specific changes in the brain’s chemistry. A research application back in 2014 by Trotti, Lynn Marie for the National Institute of Health found that the brain chemical GABA can be overactive in people with excessive sleepiness. This imbalance in neurotransmitters can make it difficult for the body to regulate sleep and wakefulness. Atypical depression is also associated with changes in neurotransmitters such as reduced dopamine and serotonin levels. 

Hypersomnia is one of the symptoms of atypical depression due to a genetic predisposition. One possible factor is the PER3 gene. This gene is involved in both mood and sleep disorders. A mutation in the gene can cause alterations in the expression or function of the PER3 protein. This, in turn, can affect the timing and quality of sleep, explains Chloe Weiss and her team in the study from the August 2020 issue of Frontiers in Psychology. When people don’t get quality sleep, it can change their mood and behavior. 

As one of the symptoms of atypical depression, hypersomnia is identified as feeling unusually tired all the time, the need for daytime naps, feeling drowsy despite sleeping and napping, and memory and concentration difficulties.

2. Increased appetite or weight gain

Increased appetite or weight gain is an intense desire for food, which results in gaining a few pounds. Increased appetite can be intermittent (come and go) or persistent (last for a long period). It is a symptom of different disorders, including atypical depression. 

Increased appetite or weight gain becomes a symptom of atypical depression because a person may use food to cope with their emotions. A systematic review by Beatriz Villagrasa Blasco et al. published in the August 2020 issue of Psychiatry Investigation shows that atypical depression can increase the risk of obesity. When people overeat, they can gain and retain excess weight. 

When someone has atypical depression, they can turn to food as a form of self-medication. Processed foods with lots of sugar and flour train the brain to crave them more instead of fruits and vegetables. These processed foods activate the dopamine centers in the brain and can temporarily boost mood. Since these foods are very addictive, it is very difficult to control the amount of food people eat. 

Increased appetite or weight gain is one of the symptoms of atypical depression because people with this mental illness are less likely to make conscious choices about their food intake. Depression is indicated by a loss of interest and a lack of motivation. A person with this condition may not be willing to put much thought into their eating or grocery shopping habits. This could lead to too much eating and subsequent weight gain, which worsens the symptoms of depression.

As one of the symptoms of atypical depression, increased appetite or weight gain is identified as having an abnormal urge to eat and intense cravings for carbohydrate-rich foods or sweets. A person may eat frequently during the day.

3. Having a more intense reaction or increased sensitivity

Having a more intense reaction or increased sensitivity is an emotional response that is more extreme than what would be considered typical for a given situation. Increased sensitivity refers to the heightened response to different stimuli including criticism.  Intense reactions or increased sensitivity are common symptoms of mental illnesses, including atypical depression. 

Having a more intense reaction or increased sensitivity becomes a symptom of atypical depression because it is a response to symptoms such as hopelessness. A person with depression often feels worthless and helpless. They realize a part of them is “lost” or it’s drowning in hopelessness. As a result, they become irritable and overreact to minor inconveniences. More precisely, a person with atypical depression becomes more sensitive due to overwhelming symptoms they’re dealing with on a daily basis.

Having a more intense reaction or increased sensitivity is one of the symptoms of atypical depression due to chemical imbalances in the brain. Depressive symptoms are associated with low serotonin levels. Changes in the concentration of this neurotransmitter can make a person feel more sensitive and overreact.

As a symptom of atypical depression, having a more intense reaction or increased sensitivity is identified as overreacting to minor inconveniences in life, becoming overly angry or upset over things that don’t require such a reaction.

4. Having a feeling of being weighed down, paralyzed, or “leaden”

Having a feeling of being weighed down, paralyzed, or “leaden” refers to a situation when a person feels as if their body is weighed down by a heavy burden. They feel heavier than normal. Anxiety can cause such an experience, but it can also be a symptom of atypical depression.

Having a feeling of being weighed down, paralyzed, or “leaden” becomes one of the symptoms of atypical depression due to fatigue. Men and women with depressive disorders experience a lack of energy or fatigue. Tiredness in depression is persistent, which can lead to the feeling of heaviness in arms and legs i.e. leaden paralysis.

Having a feeling of being weighed down, paralyzed, or “leaden” could also stem from a sedentary lifestyle or lack of motivation to be active. This acts on the muscles which become heavier and a person feels like they’re being weighed down.

As a symptom of atypical depression, having a feeling of being weighed down, paralyzed, or “leaden” is identified as feeling the limbs are made of lead and it takes an immense amount of effort to just move them. People with leaden paralysis might also feel like they are dragging themselves through the day.

What can I expect from atypical depression?

A change in sleeping and eating habits is expected in cases of atypical depression. A person with atypical depression can expect their emotions and symptoms will change over the day. For instance, they may wake up feeling okay but as the day goes on, the person becomes more discouraged, hopeless, and depressed. They can feel disheartened or gloomy, and may even experience feelings of hopelessness or despair. This despondency typically sets in as the day goes on. 

Physical symptoms can be particularly overbearing in the early evening. A person can feel as though they can sleep for days and may crave high-carb foods. 

When left untreated, complications of atypical depression are expected. Common complications include binge eating, increased risk of suicide, worsening of co-occurring medical conditions, higher risk of substance abuse and relationship problems, and absence and impaired productivity at work or school.

How is atypical depression diagnosed?

Atypical depression is diagnosed by a qualified mental health professional such as a psychiatrist, psychologist, or primary care physician. There is no specific atypical depression test, but mental health experts can use a combination of diagnostic tools. This can involve a clinical evaluation, medical history, and laboratory tests. 

A clinical evaluation involves a comprehensive assessment of the patient’s mental and physical health. Evaluation starts with a thorough medical history and physical examination. This can help rule out any underlying medical contributions that could cause the symptoms seen in atypical depression. 

During the diagnostic interview, the clinician asks the patient about their symptoms, eating, and sleeping habits. The patient should also talk about their overall mood, energy levels, and overall functioning. 

To meet the diagnostic criteria for atypical depression, the patient must have mood reactivity (the patient’s mood improves because of a positive event) and 2 or more of the following symptoms: leaden paralysis, hypersomnia, a notable increase in appetite or weight gain, or a long-standing pattern of interpersonal rejection sensitivity resulting in noticeable occupational or social impairment. 

For a patient to be diagnosed with atypical depression, they shouldn’t meet the criteria for having “melancholic depression” or “endogenous depression” and catatonia when they are depressed, explains PsychDB.

The doctor may suggest a blood test to rule out any medical conditions that could have similar symptoms to depression. These include vitamin deficiencies, thyroid dysfunction, or anemia.  Besides, for diagnostic purposes, blood tests are utilized in the treatment of this mental illness. A healthcare professional may order a blood test to determine how the patient’s body is reacting to antidepressants and adjust the dosage if necessary.

What are the available treatments for atypical depression?

The available treatments for atypical depression vary based on the symptoms, the severity of the problem, and the patient’s overall health. Healthcare experts often recommend talk therapy or a combination approach with lifestyle changes and atypical depression medication. Each of these treatments works in a unique way to alleviate the symptoms and boost the quality of life. The treatments available for patients are listed below:

• Psychotherapy (talk therapy)
• Medication
• Lifestyle changes

1. Psychotherapy (talk therapy)

Psychotherapy (talk therapy) is a form of mental health treatment that involves a therapeutic interaction between a therapist and their client. As a highly personalized and collaborative process, psychotherapy aims to improve the patient’s sense of self and their own well-being. Many types of therapy are available, but the most frequently used approach is cognitive behavioral therapy (CBT). People opt for therapy to improve their self-esteem, but it is also used for the management of addiction and mental illnesses such as atypical depression.

Psychotherapy (talk therapy) helps to treat atypical depression because it allows a patient to identify negative thinking patterns that contribute to depressive symptoms. This is done with the therapist’s help. Once a person identifies irrational thoughts that feed their depression, they learn to replace them with a more rational or positive thinking pattern. As a result, symptoms of depression become easier to manage. Patients also learn coping skills to manage their stress and overcome various challenges in life.  Psychotherapy such as CBT is goal-oriented and patient-centric; the patient takes an active role during therapy. The main point is to learn how irrational thoughts affect their emotions and behaviors in order to be empowered to change them.

Psychotherapy (talk therapy) is one of the best treatments of atypical depression because it empowers a patient to learn more about themselves and their thoughts in order to work on the root causes of their symptoms. Therapy doesn’t mask or conceal the symptoms of atypical depression. Instead, patients develop skills to cope with those symptoms and to understand why they happen. Not only does therapy help reduce symptoms of depression, but it also allows a patient to have better health in the long-run. The beneficial effect of psychotherapy is long-term, it’s not a short-term solution. 

Psychotherapy (talk therapy) is an effective treatment approach for atypical depression and its benefits are scientifically confirmed. According to a double-blind, placebo-controlled trial by Robin B. Jarrett, PhD et al. published in the May 1999 issue of Archives Of General Psychiatry, psychotherapy reduces the symptoms of depression with atypical features. Talk therapy proved more effective than placebo and as much as phenelzine (MAOI drug). The study involved 108 patients who had MDD with atypical features. They received 10 weeks of atypical depression treatment, twice a week. The results showed that cognitive therapy and phenelzine were more effective than the placebo, with a response rate of 58% for both treatments compared to 28% for the placebo. Both cognitive therapy and phenelzine were more efficient at curbing the symptoms than placebo. The study concluded that cognitive therapy could be a promising alternative to standard treatment with a monoamine oxidase inhibitor for people with MDD and atypical features.

Additionally, a randomized controlled trial that V. Henkel et al. published in 2010 in the European Psychiatry journal also confirmed that CBT is beneficial and effective for patients with atypical depression. 

How long it takes for psychotherapy (talk therapy) to take effect depends on the severity of symptoms, but six to 20 sessions may be necessary. The duration of each session is 30 to 60 minutes. Patients usually have a session once a week or once every two weeks.

2. Medication

Medication is pharmacotherapy or a drug that is formulated to treat a physical or mental illness. Medications for the treatment of depression are called antidepressants. There are different types of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). Only a healthcare expert can recommend the best form of treatment based on the patient’s symptoms and individual needs. 

Medication helps to treat atypical depression because it balances neurotransmitters in the brain and keeps them stable. For example, SSRIs (the first line of treatment for depression) enhance serotonin levels by blocking or inhibiting serotonin reuptake. This can have a profound impact on the patient’s sleep, emotional, and mood patterns, explain Andrew Chu and Roopma Wadhwa in a post Selective Serotonin Reuptake Inhibitors on the website of the National Library of Medicine. The post was last updated in February 2023. 

SNRIs stop the reuptake of both norepinephrine and serotonin thereby curbing the symptoms of depression while regulating mood. Tricyclic antidepressants work similarly to SNRIs. They affect the reuptake of serotonin and norepinephrine in a way that depends on the dosage and the metabolic characteristics of the patient. As it can be concluded by their name, NDRIs inhibit reuptake of norepinephrine and dopamine, the chemicals that also play a role in depressive symptoms when not in balance. MAOIs work by inhibiting the activity of monoamine oxidase enzymes, which are responsible for breaking down neurotransmitters. As a result, MAOIs can boost mood and decrease the symptoms of depression. 

Medication is one of the best treatments for atypical depression because it can support the effectiveness of therapy. Antidepressants such as SSRIs work well in combination with therapy because both approaches exhibit beneficial effects on the brain, according to a study by Hjorth O. et al. in the October 2022 issue of Translational Psychiatry.

Medication is effective for treatment of atypical depression, especially MAOIs according to F. M. Quitkin in a paper from the March 2002 issue of The Primary Care Companion to the Journal of Clinical Psychiatry. However, due to associated dietary restrictions and potential adverse reactions, MAOIs aren’t first-line treatment for this condition. The same paper confirms that SSRIs are effective too. Treatment with SSRIs reduces the risk of relapse and recurrence of depressive symptoms, according to a paper that S.S. Clevenger et al. published in the January 2018 issue of Therapeutic Advances in Psychopharmacology.

It takes two to four weeks for antidepressants to take effect, but it may take up to eight weeks for a patient to experience the full effect of the medication.

3. Lifestyle changes

Lifestyle changes are defined as behavior modifications or habit changes that support positive changes in a person’s life or aid the management of physical and mental illnesses. These changes involve several aspects of life including sleep, diet, and physical activity levels. 

Lifestyle changes help to treat atypical depression because an unhealthy lifestyle can contribute to the development of atypical depression and worsen its symptoms. For example, alcohol and drug use can worsen the atypical depression symptoms. The chemicals in alcohol and drugs can disrupt the delicate balance of brain chemicals. This can lead to mood swings, making it difficult to regulate depression. Substance abuse can exacerbate the physical symptoms of depression, such as changes in sleep patterns and appetite. Lack of sleep, unhealthy diet, stress, and sedentary lifestyle can also increase the risk of atypical depression or worsen symptoms in people who have it. Getting too much sleep is also a problem among people with atypical depression. A study by Damien Léger and a team of experts issued in the September 2014 issue of PLOS One journal shows that long sleep can lead to hypertension, diabetes, obesity, and other cardiovascular problems. When a person oversleeps, they are less likely to exercise and more likely to skip meals. So, when they wake up, they can overeat or try to satisfy their food cravings with high-carb foods. This, in turn, can worsen the symptoms of depression and cause loss of motivation, low energy, and increased fatigue. Changing these unhealthy habits and adopting more positive changes can support mental and physical health thereby making it easier to manage depression. 

Lifestyle changes are one of the best treatments for atypical depression because they give a person a sense of control and accomplishment. The core features of depressive disorders are loss of interest and motivation. Not only are they symptoms of depression, but they also make the condition worse and more severe. Introducing lifestyle changes gives people a sense of purpose and accomplishment. This motivates them to keep going, which positively affects their mental health. Witnessing progress and results from exercise, a healthy diet, or getting enough sleep also increases self-esteem and confidence. Better self-esteem can help reduce symptoms of depression. 

Lifestyle changes are effective for the treatment of depression and multiple studies have confirmed so. For example, regular exercise is a natural mood booster. Based on a report from Ashish Sharma, M.D. et al. published in the February 2006 issue of Primary Care Companion to the Journal of Clinical Psychiatry, any form of physical activity can prove useful. Aerobic workouts, such as dancing, jogging, swimming, gardening, dancing, and cycling are effective at curbing the symptoms of depression and anxiety. At the same time, a paper by O. Pano et al. in the November 2021 issue of the World Journal of Psychiatry confirmed that a healthy diet (especially the Mediterranean diet) can help manage depressive symptoms and improve quality of life. Practicing mindfulness is also an effective approach, especially because mindfulness is associated with lower levels of depression according to a paper by F.B.R. Parmentier et al. in the March 2019 issue of Frontiers in Psychology.

How long it takes for lifestyle changes to take effect varies from person to person. Exercise can work instantly and provide short-term mood-related benefits, but it may take several weeks to experience the best results. The same applies to diet, sleep changes, and mindfulness.

What are the side effects of atypical depression treatment?

Although antidepressants can be helpful, there are potential negative consequences to using them. They have similar effectiveness but differ in their safety profile and adverse reactions. Some of these include:

• Nausea/diarrhea
• Loss of appetite
• Headaches
• Insomnia
• Loss of sex drive

1. Nausea/diarrhea

Nausea and diarrhea become a side effect of atypical depression treatment because they are an adverse reactions to antidepressants that are a part of the treatment for this condition.

Nausea and diarrhea are one of the side effects of atypical depression treatment because an increase in serotonin levels, which is a mechanism of action of antidepressants, can upset the stomach and cause gastrointestinal problems such as nausea or vomiting. Additionally, antidepressants can affect the motility of the gastrointestinal tract by changing the levels of serotonin and norepinephrine in the brain. These neurotransmitters are also present in the gastrointestinal tract and regulate digestion and bowel movements. Altering the levels can cause nausea and diarrhea. According to a paper by Karen Kelly, MD et al. published in the December 2008 issue of Dialogues in Clinical Neuroscience, these side effects can be transient and subside in weeks. But, in some patients, they can persist and cause a wide range of problems. When diarrhea lasts a long time, it causes a severe loss of fluids. This can make it difficult for the body to receive and retain nutrients.

As a side effect of atypical depression treatment, diarrhea, and nausea are identified as frequent or loose and watery stools, abdominal cramps, profuse sweating, lack of appetite, and urge to vomit. These symptoms occur once a patient starts taking the medications.

2. Loss of appetite

Loss of appetite becomes a side effect of atypical depression treatment because it is a reaction to antidepressants. Loss of appetite can have a negative impact on a patient’s body and overall health. Patients can lose weight and are also less likely to consume enough nutrients. The loss of nutrition can cause a range of physical and mental problems.

Loss of appetite is one of the side effects of atypical depression treatment due to changes in levels of hormones and neurotransmitters that are involved in appetite regulation, such as cortisol, leptin, and ghrelin. Changes in these hormones can lead to changes in appetite and weight. Additionally, serotonin helps regulate appetite, which is why the changes in levels of neurotransmitters can also contribute to loss of appetite. Serotonin may activate neurons that decrease appetite and block neurons that increase it.

As a side effect of atypical depression treatment, loss of appetite is identified as reduced desire to eat, not feeling hungry, and feeling nausea at the idea of eating.

3. Headaches

Headaches become a side effect of atypical depression treatment because it’s an adverse reaction to antidepressants, which can affect the amount of sodium in the blood. The drugs can drastically reduce sodium levels and cause a condition known as hyponatremia. 

Sodium is an essential mineral that helps regulate the balance of fluids in the body. When there is too little sodium in the blood, it can cause water to move into the cells, causing swelling and other problems. That’s why patients with hyponatremia can experience headaches and confusion. The risk of developing hyponatremia varies depending on the specific medication, dosage, and individual factors. The odds of developing this condition are much higher during the first 2 to 4 weeks of antidepressant treatment, explains Sarah Ludwig Rausch for WebMD. 

Headaches are one of the symptoms of atypical depression because serotonin causes narrowing of blood vessels throughout the body. As a result, a person may experience headaches or even migraines.

As a side effect of atypical depression treatment, headaches are identified as pain on one or both sides of the head, the intensity of pain is mild to moderate, and pain appears dull or feels like a band around the head.

4. Insomnia

Insomnia becomes a side effect of atypical depression treatment because it’s the way a person’s body reacts to the presence of antidepressants. This usually happens as the body adjusts to the medication.

Insomnia is one of the side effects of atypical depression treatment because the medication activates specific receptors in the brain called serotonergic 5-HT2 receptors. The drugs can also enhance the levels of norepinephrine and dopamine. These neurotransmitters regulate sleep. So, increasing their levels can cause sleep disturbances and disrupt the patient’s natural sleep-wake cycle.

As a side effect of atypical depression treatment, insomnia is identified as inability to fall asleep or stay asleep, waking up frequently during the night, difficulty falling asleep again, and tiredness during the day due to a sleepless night.

5. Loss of sex drive

Loss of sex drive becomes a side effect of atypical depression treatment because it is an adverse reaction to antidepressants and serotonin changes in the brain. Rising levels of serotonin can prevent sex hormones from transmitting their messages to the brain. For example, some medications lower testosterone levels in men or increase prolactin levels in both women and men. This can lead to a decrease in sexual desire. According to a study by Tierney Lorenz, PhD, et al. published in the September 2016 issue of Mayo Clinic Proceedings, the odds of antidepressants causing problems with sex drive are relatively high. About 83% of women taking antidepressants had problems with arousal and 72% with sexual desire. 

On that note, men and women experience different sexual side effects from antidepressants. Men tend to have more problems with sexual desire and orgasm while women often experience issues with sexual arousal, especially when taking SSRIs. Roughly 42% of women using SSRIs reported having difficulties achieving an orgasm. 

Loss of sex drive is one of the side effects of atypical depression treatment because antidepressants can cause lubrication problems, which can make sex painful. In men, antidepressants can impair erectile function. These sexual problems can affect a person’s libido. 

As a side effect of atypical depression treatment, loss of sex drive is identified as reduced desire to have sexual intercourse and having a decrease in sexual fantasies or thoughts of sex.

Can atypical depression be treated?

Yes, atypical depression can be treated, but there is no definitive “cure” for this condition. There are effective treatment options that can mitigate the symptoms involving a combination of psychotherapy, medication, and lifestyle changes. 

Antidepressants such as SSRIs and MAOIs can be efficient at curbing the symptoms and improving the quality of life while psychotherapy can help address the negative thought pattern and improve interpersonal relationships. 

With lifestyle changes, people can create an excellent starting point for the other treatment approaches to work. By keeping the body in good shape and supplying it with all the nutrients and vitamins it needs, the organs can function better. Regular exercise, healthy diet, adequate sleep, and stress reduction can improve mood and decrease the symptoms of depression.

How to prevent having atypical depression?

Atypical depression is a complex health problem and there is no guaranteed way to prevent it. But, there are some steps that people can take that could potentially lower their risk or reduce the severity of the symptoms. 

• Practice self-love and self-care: Self-love means accepting yourself with all your flaws and imperfection. Instead of comparing yourself with others and feeling self-critical, you should celebrate your accomplishments and practice positive self-talk. Self-care means taking the time to relax, meditate, exercise, take a bath, etc. It’s important to listen to your body regularly. This includes getting enough sleep, eating a balanced diet, and keeping stress to a minimum. 
  
• Seek early treatment: Certain health problems can increase the risk of atypical depression such as a history of anxiety or bipolar disorder. Get treatment for these conditions to try and prevent atypical depression.
  
• Build a supportive social network: Loneliness and isolation can worsen your depression. By connecting with others, you can open up more and talk about your feelings. Maintaining positive relationships can ease some of the stress and tension from daily life.
  
• Avoid substance or alcohol abuse: Find healthy ways to cope with stress instead of relying on drugs and alcohol. Options like deep breathing, mindfulness meditation, and talking to a mental health expert can help.

How to deal with atypical depression?

In order to deal with atypical depression, it is necessary to get professional medical treatment. Atypical depression is a type of mental illness, and like any other illness, it is best to seek help. People should take care of their mental health like they would with any other part of their body. Find a therapist you are comfortable with and has a good track record.

To deal with atypical depression, it is important not to feel shame about seeing a therapist or taking antidepressants. This is something that can improve your health and quality of life. 

Also, start forgiving yourself for the things you want to do, but can’t because of your current mental state. Many patients feel stuck in a rut of not getting things done or feeling incapable to succeed. But, when someone is struggling with a mental illness, it can be difficult to find the motivation or energy to achieve certain tasks. When you forgive yourself, you can create a more comfortable mental state, in the moment, that can ease some of that pressure. 

Finally, find something that lets you feel useful despite your current mental state. For example, some patients engage in creative activities, such as knitting, painting, songwriting, etc. These are all activities that can improve mood and give people a safe space to express themselves. It’s important to engage in activities or hobbies that can help you unwind and break from the stress.  

Practicing relaxation techniques can aid in managing atypical features of depression. Atypical depression makes it difficult for people to relax and unwind. By implementing options, such as meditation and deep breathing techniques, people can curb their anxiety and promote a sense of calm. Deep breathing means taking slow, and deep breaths. This is something people can use when they experience tension or anxiety. By focusing on their breathing patterns, people can keep their heart rate stable and de-stress. Meditation is another option for achieving mental clarity and a state of calm. It can be effective for regulating the stress response and alleviating the symptoms of atypical depression. When used together, both of these techniques can improve emotional regulation and relaxation.

What is the difference between atypical depression and major depression?

Both atypical depression and MDD have many symptoms in common such as low mood, reduced interest in activities, and feelings of hopelessness or worthlessness. However, they differ in many ways. 

One of the hallmarks of atypical depression is mood reactivity. The big difference is that when something positive happens, like an experience or an event, the atypical symptoms subside. But, a positive experience may not be enough to improve persistently low mood in people with MDD. 

Another difference is in the physical symptoms. Atypical depression leads to weight gain, excessive sleeping, increased appetite, and leaden paralysis. Leaden paralysis isn’t common in people with MDD.

The two disorders also differ in terms of behavioral symptoms. Patients with atypical features often have a heightened and persistent sensitivity to feelings of rejection or social exclusion. These symptoms aren’t that emphasized in people with MDD.

There can also be a different treatment response, explain Verena Henkel et al. in a meta-analysis published in the January 2006 issue of Psychiatry Research Journal. Patients with atypical features tend to have a better response rate to MAOIs (a certain type of antidepressant) compared to those with MDD. 

Atypical depression begins at an earlier age and lasts longer than MDD. Atypical depression tends to begin in adolescent years or early 20s. The average age of onset of MDD is between 35 and 40 years of age.