Despite its name, atypical depression is one of the most common types of depression, affecting between 25 to 40 percent of depressed people. Because the symptoms differ from those of typical depression, this subtype of depression is often misdiagnosed.
Atypical depression was named in the 1950s to classify a group of patients who did not respond to electroconvulsive therapy or to the tricyclic antidepressant Tofranil (imipramine). They did, however, respond to monoamine oxidase inhibitor (MAOI) antidepressants.
Some of the same treatments that work for classic depression work for atypical depression, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy; however, full recovery is more achievable when this type of depression is identified and addressed.
Here are a few facts about atypical depression you should know.
Fact One: Atypical Depression Usually Involves Mood Reactivity or Extreme Sensitivity
One of the distinguishing features of atypical depression is “mood reactivity.” A person’s mood lifts in response to actual or potential events. For example, she may be able to enjoy certain activities and is able to be cheered up when something positive happens — like when a friend calls or visits — while a person with classic major depression shows no improvement in mood.
On the flip side, a person with atypical depression also responds to all things negative, especially interpersonal matters, such as being brushed off by a friend or something perceived as a rejection. In fact, a personal rejection or criticism at work could be enough to disable a person with atypical depression. There is a long-standing pattern of rejection sensitivity with this kind of depression that can interfere with work and social functioning.
Fact Two: People with Atypical Depression Tend to Overeat and Oversleep
Instead of experiencing interrupted sleep and loss of appetite as people often do with typical major depressive disorder, people with atypical depression tend to overeat and oversleep, sometimes referred to as reversed vegetative features. It’s not uncommon for someone with atypical depression to gain weight because they can’t stop eating, especially comfort foods, like pizza and pasta. They could sleep all day, unlike the person with typical depression experiencing insomnia.
Oversleeping and overeating are the two most important symptoms for diagnosing atypical depression according to a study published in the Archives of General Psychiatry that compared 304 patients with atypical depression with 836 patients with major depression.
Fact Three: People with Atypical Depression Can Experience Heavy, Leaden Feelings
Fatigue is a symptom of all depression, but persons with atypical depression often experience “leaden paralysis,” a heavy, leaden feeling in the arms or legs.
According to Mark Moran of Psychiatric News, a depressed patient gave a graphic portrayal of his symptoms to researchers at Columbia University College of Physicians and Surgeons 25 years ago: “You know those people who run around the park with lead weights? I feel like that all the time. I feel so heavy and leaden [that] I can’t get out of a chair.” The researchers labeled the symptom “leaden paralysis” and incorporated it into the criteria of diagnosis of atypical depression.
Fact Four: Symptoms Usually Begin at an Earlier Age, Are Chronic, and Affect More Women
Atypical depression tends to begin at an earlier age (younger than age 20), and is chronic in nature. Michael Thase, M.D., Professor of Psychiatry at Perelman School of Medicine at the University of Pennsylvania, discussed atypical depression in a Johns Hopkins Depression & Anxiety Bulletin, where he said, “The younger you are in adult life when you start to have trouble with depression, the more likely you are to have reverse vegetative features. In other words, the likelihood that you’ll overeat and oversleep when depressed is dependent on the age at which you become ill.” This was the subject of a 2000 study published in Journal of Affective Disorders. The illness of the patients with early-onset of atypical depression looked entirely different from those diagnosed with a classic melancholic depression.
Atypical depression also seems to affect more women than men, especially women before menopause. “Ultimately, I see atypical depression as a subtype of depression that reflects the convergence of an early age of onset, female gender, and a chronic but less severe form of major depression throughout pre-menopause,” writes Dr. Thase.
Fact Five: Atypical Depression Often Coincides with Bipolar Disorder and Seasonal-Affective Disorder
Atypical depression is more likely to occur in people with bipolar disorder and seasonal affective disorder. A study published in the European Archives of Psychiatry and Clinical Neuroscience evaluated 140 unipolar and bipolar outpatients who had symptoms of an atypical major depressive episode. The prevalence of bipolar II disorder was 64.2 percent.
In another study published in Comprehensive Psychiatry, 72 percent of 86 major depressive patients with atypical features were found to meet the criteria for bipolar II disorder. There have also been studies reviewing the overlap between atypical depression and seasonal affective disorder, highlighting common biological links underpinning common symptoms.