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Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
When you see the word “depression,” what do you think of? For many people, depression is a broad term that’s used to refer to any mood disorder that involves feelings of sadness, guilt or hopelessness.
While this is an accurate description of major depressive disorder (MDD, or simply depression), the reality is that depression comes in many different forms.
One form of depression that’s less well understood is atypical depression, or major depression with atypical features.
Atypical depression has unique symptoms. According to the journal, Neuropsychiatric Disease and Treatment, these include increased hunger, sleepiness and a feeling of extra weight in the arms and legs.
Atypically depressed patients often respond best to different forms of treatment, including specific antidepressants.
Below, we’ve explained what atypical depression is, as well as how it differs from more common forms of depression such as major depressive disorder.
We’ve also discussed how atypical depression is treated, as well as the steps that you can take to seek help if you’re concerned that you may have this form of depression.
Atypical depression is a specific form of depression that involves a mix of conventional and less common symptoms.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), atypically depressed patients often have symptoms of major depression, but they also show atypical features, such as feeling better in positive situations and experiences, an increase in appetite, excess sleep and changes in the perceived weight and sensation of the limbs.
Several other conditions, including obesity, bipolar disorder and seasonal affective disorder (SAD), a form of depression that can develop during the winter months, are also atypical features
Atypical depression is one of the common types of depression. Data from epidemiological studies published in the journal, Journal of Neuropsychiatric Disease Treatment, suggests that between 15 and 29 percent of people diagnosed with depression have atypical depression.
Interestingly, atypical depression holds far more prevalence in women than in men. In fact, this same research has found that women are approximately two to three times more likely to develop atypical depression than men.
Like other forms of depression, atypical depression is treatable. It’s almost always treated with antidepressants, psychotherapy or a combination of different treatment options.
If you’re affected by atypical depression, you may experience many of the common features of a major depressive episode. According to the National Institute of Mental Health and the previously mentioned DSM-IV (published by the American Psychiatric Association), these include the following symptoms:
Persistent sad or empty depressed mood (dysthymia). You may feel persistently unhappy or empty or take on a persistently depressed moon even in situations that would normally involve happiness and satisfaction.
Feelings of pessimism or guilt. Regardless of the situation, you may feel like there’s no hope, or that you’re guilty of something.
Decreased energy. You may constantly feel fatigued, even when you eat normally and get a normal amount of sleep.
Difficulty concentrating and/or remembering information. You may find it difficult to focus on specific tasks, remember information or make decisions.
Loss of interest in activities and hobbies. You may no longer feel interested in your hobbies, passions and favorite activities, even if they used to bring you pleasure.
Pains, cramps, headaches and digestive problems. You may feel pain, discomfort or other physical symptoms without a clear, obvious cause. These symptoms may not get better even with active, ongoing treatment.
Suicidal thoughts. You may experience thoughts involving death or suicide, or attempt to injure yourself or take your own life.
You may also have symptoms that are unique to atypical depression. Atypical symptoms include one or several of the following:
Mood reactivity. People with atypical depression often feel better after positive events. You may temporarily feel happier after spending time on your hobbies, meeting up with friends and family members or doing other things that you enjoy.
Increased appetite and weight gain. Atypical depression often involves an increase in your appetite (at its extreme, called hyperphagia). You may notice that you feel the urge to eat more often, or that you eat a larger amount of food with each meal. This may cause significant weight gain.
Excessive sleep (hypersomnia). People with atypical depression often experience an excessive need to sleep, either during the day or at nighttime. You may find it harder than normal to get out of bed in the morning, or feel a persistent need to nap during the day.
Leaden paralysis. Atypical depression can cause a symptom called leaden paralysis — a sense of heaviness in your arms and legs. Your limbs may feel unusually heavy, and you may experience noticeable fatigue when you move them.
Interpersonal rejection sensitivity. Atypical depression can cause impairment in your rejection sensitivity, causing you to feel more severely hurt or unhappy if you perceive that someone is rejecting or criticizing you.
Some people with atypical depression notice that their depressive symptoms are more severe in the evening than during the daytime.
Atypical depression often develops during childhood or adolescence. For many people, it can be a chronic issue that involves alternating periods of mild and severe symptoms.
Like with other forms of depression, experts aren’t yet completely aware of what causes atypical depression to develop.
Currently, research suggests that depression typically develops due to a combination of genetic, biological, psychological and environmental risk factors. In some cases, specific illnesses can play a role in the development of depression.
You may have an increased risk of developing depression if you have a family history of depression, if you use certain types of medication or if you experience a sudden negative change in your life, such as a major loss or chronic stress.
Our guide to the causes of depression goes into more detail about the factors that may play a role in the development of this common mental disorder.
If you think you might have atypical depression, it’s important to reach out to a licensed mental health provider for advice and assistance.
You can seek help for atypical depression by talking to your primary care provider, contacting a licensed mental health provider in your city or connecting with a psychiatry provider online with our online psychiatry service.
As part of the diagnostic criteria, you may need to complete a physical exam or a psychological evaluation.
Your healthcare provider may request a blood sample to test for physical issues that could play a role in your depression, such as nutritional or hormonal deficiencies.
Your healthcare provider may ask you about your background, personal history and your use of medication or drugs. Make sure to answer your healthcare provider’s questions honestly and in as much detail as possible.
If you’re diagnosed with atypical depression, your healthcare provider may prescribe medication to control your symptoms, recommend therapy or suggest a combination of treatments.
Depression is often treated using antidepressants. According to the Institute for Quality and Efficiency in Health Care, these medications work by increasing the availability of certain mood-regulating chemicals, referred to as neurotransmitters, throughout your brain and body.
Several types of antidepressants are commonly used to treat depression, including selective serotonin reuptake inhibitors (SSRIs) and older medications such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).
Your healthcare provider may prescribe you an SSRI or MAOI antidepressant. These types of antidepressants are usually the most effective at treating atypical depression.
Some antidepressants used to treat atypical depression can cause side effects and potentially harmful interactions. For example, research published by StatPearls says that some MAOIs may interact with both medications and foods that contain the amino acid tyramine.
Our guide to antidepressant side effects provides more information about these issues, as well as the steps that you can take to keep yourself safe while using antidepressants.
Make sure to closely follow your healthcare provider’s instructions if you’re prescribed any type of medication to treat atypical depression.
Like other forms of depression, atypical depression often improves with psychotherapy, or talk therapy.
Your mental health provider may use cognitive behavioral therapy (CBT), interpersonal therapy or other forms of therapy to help you overcome your symptoms.
Therapy for depression often involves using problem-solving techniques to help you overcome difficult life experiences.
Our full guide to therapy for depression goes into greater detail about the forms of therapy used in the treatment of depression.
Depression, including atypical depression, often improves with positive habits and changes to your lifestyle. Try making the following lifestyle changes in combination with medication and/or therapy:
Exercise frequently. Exercise has numerous benefits for your mental health, including relieving many forms of depression. Experts at Harvard Medical School believe that this may be due to the effects of exercise on your hippocampus, a part of your brain that controls your moods. The CDC advises that you should try to get at least 150 minutes of aerobic exercise per week (for example, brisk walking around your neighborhood), as well as two strength-based workouts.
Reach out to friends and family. When you have atypical depression, it’s easy to stay away from social activity. This may make your depression worse by causing you to feel isolated and alone. Try to spend time with your friends and family. Simple things such as meeting for lunch or going for a walk together can have a real positive impact on your well-being.
Set realistic, achievable goals for your recovery. As you’re recovering from atypical depression, it’s important to set realistic goals for yourself so that you can monitor your progress. Set simple, easily measurable goals like exercising a certain number of times per week, meeting up with friends every weekend, or taking part in a support group or other social engagement.
Try meditation and other stress management techniques. According to Harvard Medical School, meditation can help your brain better deal with stress, depression and anxiety. Try simply at-home meditation to keep yourself calm and focused on making improvements.
Avoid alcohol and recreational drugs. The journal, ISRN Psychiatry, says that alcohol use, especially excessive alcohol use, is closely linked to depression. To improve your recovery, avoid using alcohol or illicit drugs while you focus on treating atypical depression.
Avoid making important decisions while you’re depressed. Depression can affect your ability to make major decisions, says the National Institute of Mental Health. As such, it’s best to postpone big decisions, such as switching jobs or making changes to a relationship, until you’re feeling better.
Be patient with medication and therapy. Antidepressants and therapy both work well, but they’re not overnight cures for depression. Focus on making steady progress and be prepared to wait for several weeks for your treatment to start working. If you don’t feel any improvements after a few months of treatment, make sure to let your mental health provider know. If your symptoms get worse while on medication treatment, contact your healthcare professional immediately.
If you are noticing symptoms of atypical depression, it is important to seek medical attention as soon as possible. Like many other depression and anxiety disorders, atypical depression can get worse over time if not treated properly.
It’s important to seek professional help if you think you may have atypical depression. A mental health professional can provide an accurate diagnosis and, if appropriate, prescribe medication to help you gain more control over your thoughts, feelings and other symptoms.
You can get help for atypical depression online with our online psychiatry service, which allows you to connect with a licensed psychiatry provider from your home.