This variety of depression begins early — median age of onset is 17 — and takes a chronic course. Depression afflicts many family members, and it tends to be of the same chronic type.

Perhaps the landmark feature of atypical depression is its responsiveness to one class of antidepressants, the MAO inhibitors. While they are no longer considered a first-line treatment because of their onerous side effects, they are regarded especially useful for people with atypical depression who fail to respond to other drugs. Cognitive therapy in conjunction with drug treatment is also effective and helps restore function.

A biology of atypical depression has not been delineated, as patients appear normal on most physiologic tests. But patterns of response to mixed-up images of faces suggests that parts of the brain that interpret emotion are not working normally.

Anxious depression covers the large gray area where symptoms of depression and anxiety co-exist or overlap. Patients typically have feelings of worthlessness and pessimism, excessive worrying and guilt, and are unable to enjoy things. The disorder is expressed physically in diminished appetite, poor sleep with frequent awakenings, and restlessness and psychomotor agitation.

In one study of 255 depressed outpatients that he conducted, psychiatrist Maurizio Fava, M.D., of Harvard reported at the symposium, 51% were found to have anxiety along with their depression. It’s not clear whether the anxiety follows on the heels of feelings of worthlessness. But in 40% of the anxiously depressed, the anxiety disorder started first.

Among those whose anxiety takes the form of social phobia and generalized anxiety disorder, the anxiety tends to precede major depressive disorder. But in the case of panic disorder it usually follows the onset of the depressive disorder.

Patients are young — average age 20.6 versus 28.4 among those with major depression alone — significantly functionally impaired, and take more time to recover. They are less likely to respond to treatment and more likely to relapse, and experience less change in their depressive symptoms with treatment.

The disorder may have its origins early in life among children of a distinct temperament type who are frightened by novelty. Both the anxiety and depression may be the outcome of abnormaly high levels of hormones driving the body’s stress response system.

    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
    Published on PsychCentral.com. All rights reserved.