What Is Atypical Depression?

Atypical depression is a type of depression that does not follow what was thought to be the "typical" presentation of the disorder. People with atypical depression experience mood reactivity. In other words, a person's mood can temporarily improve if something positive happens.

Atypical depression, which is now referred to as major depressive disorder with atypical features, is actually quite common. Unlike other forms of depression, people with atypical depression may respond better to a type of antidepressant known as a monoamine oxidase inhibitor (MAOI).

Symptoms of Atypical Depression

People with atypical depression signs and symptoms experience the core symptoms of depression, such as:

• Low mood
• Appetite changes
• Difficulty sleeping
• Agitation
• Fatigue
• Difficulty concentrating

In addition, they may experience the following symptoms:

• A mood that temporarily brightens after a positive event or happy news
• Increased appetite and weight gain
• A heavy feeling in the arms or legs
• Body aches
• Sleeping for long periods at night or during the day (hypersomnia)
• Extreme sensitivity to rejection or perceived criticism

Less common symptoms include:

• Insomnia
• Headaches
• Eating disorders
• Poor body image

What Causes Atypical Depression?

The reasons some people experience atypical depression are not known. Brain chemistry, including problems with the functioning of neurotransmitters and neurotransmitter receptors, may play a role. However, research suggests that serotonin imbalances are not the primary cause of depression.

Other factors that can raise your risk for atypical depression include:

• Family history. You are more likely to experience symptoms of atypical depression if others in your family also have depression or another type of mood disorder.
• Certain medical conditions. You may be more likely to experience atypical depression if you have a history of bipolar disorders, anxiety disorders, avoidant personalities, body dysmorphic disorder, or social anxiety disorder.
• Substance use. Having a history of substance use can also increase the likelihood of depression. 
• Stress and trauma. Experiencing stressful or traumatic experiences, including adverse events during childhood, can increase a person's risk of developing atypical depression.

How Is Atypical Depression Diagnosed?

Making a correct diagnosis is a critical step in getting treatment. Unfortunately, unlike many other health conditions, there isn’t a lab test, X-ray, or physical exam that can provide a definitive diagnosis.

To rule out any health conditions that may cause symptoms of depression or be an underlying cause, you may be given a blood test, drug screen, and imaging tests (such as a CT scan or MRI of the brain).

You'll likely undergo a depression test, either orally, on paper, or on a digital device before seeing the physician. Doctors typically compare your answers to the diagnostic criteria in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5-TR)—but that's only part of the diagnostic puzzle.

Atypical Depression Diagnostic Criteria

According to the DSM-5-TR, to be diagnosed with depressive disorder with atypical symptoms, a person must exhibit the ability to feel better temporarily in response to a positive life event (mood reactivity), plus any two of the following criteria for two or more weeks:

• Excessive eating or weight gain
• Excessive sleep
• Fatigue, weakness, and feeling "weighed down"
• Intense sensitivity to rejection
• Strongly reactive moods

Treatment for Atypical Depression

Treatment for atypical depression often involves the use of medication, psychotherapy, and lifestyle changes.

Medications for Atypical Depression

Selective serotonin reuptake inhibitors (SSRIs) and other relatively new medications are often the first-line choices for depression treatment because of their favorable side effect profiles. However, some research indicates that patients with atypical depression respond better to monoamine oxidase inhibitors (MAOIs).

Some common MAOIs include:

• Nardil (phenelzine)
• Parnate (tranylcypromine)
• Marplan (isocarboxazid)
• Emsam (selegiline)

Still, SSRIs may be prescribed first simply because they do not have the potentially serious side effects or dietary restrictions that MAOIs do. For example, to prevent dangerous blood pressure spikes, the person must avoid foods and beverages high in tyramine while taking MAOIs.

Psychotherapy for Atypical Depression

Psychotherapy, or talk therapy, is also an important part of a treatment plan for atypical depression. Cognitive-behavioral therapy (CBT) has been scientifically proven effective in treating symptoms of depression.

Other types of psychotherapy that may be used for atypical depression include:

• Behavioral therapy
• Cognitive therapy
• Dialectical behavioral therapy
• Individual, group, and family therapy
• Interpersonal therapy
• Psychodynamic therapy

Along with medication and psychotherapy, treatment for atypical depression may also include 30 to 45 minutes of light therapy (phototherapy) each morning, using a light box with a minimum power rating of 10,000 lux.

Coping With Atypical Depression

If atypical depression is interfering with your daily activities, working with your doctor to develop a treatment plan with medication and psychotherapy is a great first step. Beyond that, lifestyle modifications can help ease the symptoms and help you cope. 

Prioritize Nutrition and Exercise

Doing your best to stick with a healthful diet and regular exercise program will improve your overall health and help decrease the symptoms of atypical depression. Aim to exercise five days a week for 30–60 minutes a day.

Find Effective Relaxation Techniques

Practice mindfulness meditation and deep breathing. Deep-breathing exercises combined with mindfulness meditation can teach you to be aware of your thoughts and feelings without reacting to them.

Write in a Journal

Journaling, or expressive writing, is a highly recommended tool for dealing with depression. Whether you do it daily or weekly, this habit can help you explore your feelings and counteract the effects of stress.

Seek Support

Developing strong social support is important. This might include trusted family and friends or an online or in-person depression support group with whom you can connect and share your feelings and experiences. 

Takeaway

See a mental health professional rather than your primary care physician for the best atypical depression treatment options. Not all types of depression are alike, nor do they respond to the same medications. A physician in general practice is not likely to have the experience necessary to differentiate between depression subtypes or their most effective treatments.

If you must see a primary care physician for your treatment—perhaps because of insurance or financial considerations—do the legwork to make up for the potential deficit in your physician's knowledge. If you educate yourself and take an active role in your treatment, you're less likely to slip through the diagnostic cracks.