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Atypical depression differs from classic depression, but isn't as uncommon as the name suggests. Could you be suffering from it?

Danette had been diagnosed with major depressive disorder, but some internet sleuthing led her to suspect the label wasn't quite right — "I had an increased appetite and weight gain rather than weight loss, was weighed down by a constant 'heaviness', knew I was anxious, overslept rather than struggling with insomnia, and actually did have moments when I didn't feel depressed". Most troubling of all, the antidepressant she'd been prescribed wasn't working out. 

Thanks to the internet, being an informed and active patient has never been easier — whether you've had a diagnosis you think is wrong, or are just beginning to explore what "name" your collection of symptoms could have. Danette's stumbling, quite accidentally, on an article about atypical depression eventually led to a greater understanding of the nature of her depression. 

Could you, too, suffer from atypical depression?

What is atypical depression?

"Atypical depression" or "depression with atypical features" isn't a diagnosis in itself, but rather an "add-on" to a diagnosis of major depressive disorder or persistent depressive disorder (dysthymic depression). Despite it's name, atypical depression isn't at all uncommon — various studies have found it strikes somewhere between 18 and 36 percent of people with major depressive disorder. 

How do the symptoms of atypical depression differ from those of major depression?

Danette's symptoms, which were pretty textbook, already give us a good insight into the ways in which atypical depression differs from "just depression":

  • People with atypical depression tend to experience increased appetite and weight gain, rather than loss of appetite and associated weight loss. 
  • Atypical depression sufferers tend to have a physical "heaviness", often of the arms or legs, which is referred to as leaden paralysis. 
  • People with this diagnostic specifier often have no trouble sleeping, but rather oversleep and still feel fatigued during the day.
  • Atypical depression patients often "perk up" in response to good news, temporarily finding relief from their symptoms. This is called mood reactivity. 
  • Sensitivity to rejection is another hallmark feature of atypical depression — if you have it, you may be very down when someone criticizes or rejects you in some way. 

As with major depressive disorder in general, atypical depression can be mild, moderate, or severe. 

It's also interesting — and perhaps relevant to you personally — to note that atypical depression often exists alongside an anxiety disorder, as well as that it's not uncommon for people with atypical depression to initially be misdiagnosed with some personality disorder, frequently borderline or histrionic personality disorder. 

Though you'll have no problem finding researchers arguing about whether depression with atypical features is even a valid "category" of depression at all if you take a peek at studies, there is no doubt that the symptomatic picture described above matches a great many people. That matters because atypical depression is more than just a label your psychologist gives you — the treatment approach is also quite different from classic depression. 

How is depression with atypical features treated?

The term atypical depression has been around since the late 1950s, when researchers first discovered that a group of depressed patients didn't find symptom relief after taking tricyclic antidepressants (TCAs) but instead benefited from monoamine oxidase inhibitors (MAOIs). Since MAOIs, the oldest class of antidepressants, often come with rather bad side effects and require a special diet, they're no longer very popular — but they're still on the table for atypical depression. Phenelzine (Nardil) is the most commonly used of these drugs, and it can help you fight anxiety as well as depression. 

While TCAs are still not a good option in the treatment of atypical depression, SSRIs like sertraline (Zoloft) and fluoxetine (Prozac) have since been found to work well for many patients. SSRIs have fewer side effects and don't come with dietary restrictions, and it's most likely your doctor will suggest an SSRI to you initially. They cannot, however, be combined with a MOAI. 

Alongside antidepressant treatment, talk therapy like cognitive behavioral therapy and interpersonal therapy can play a key role in your treatment. Since people with atypical depression do often react well to positive events, generally suggested lifestyle changes like regular exercise, a set routine, and good self care may have an even greater impact on their wellbeing than it would in people with classic depression. 

What if you think you could have atypical depression?

Some people who suspect they could have atypical depression will have already received a diagnosis — one they now feel is wrong — while others haven't yet sought any help for their symptoms at all. The answer is, essentially, the same for both groups: talk to your doctor. Let them know what you have been feeling, for how long, and how intensely, and explain why you think the label of depression with atypical features could apply to you. 

If you haven't already been diagnosed with some other kind of depression, this will set a diagnostic process than may well include physical exams and lab tests in motion, in order to determine whether your symptoms may be better explained by a physical condition such as hypothyroidism. After that, a psychological evaluation is conducted to explore your symptoms and circumstances in more depth, and your doctor will use the DSM-5, the current version of the Diagnostic and Statistical Manual of Mental Disorders, to assess what diagnosis — and specifier — best matches you. 

Should atypical depressed be diagnosed, you can expect to be offered an SSRI first. Danette found that Celexa worked well for her, but is also attending therapy because, as she says, "I don't want to have to rely on antidepressants for a long time". Alongside self-care tips, therapy should also be offered to you in addition to an antidepressant. 

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