Atypical Depression

Atypical depression is a subtype of Major Depressive Disorder (MDD). Its symptoms can vary from general or ‘typical’ depression, and hence the name. MDD, also known as clinical depression, is a mental health disorder, which can be characterized by constant sadness, lack of interest in everything, loss of enthusiasm, etc.

In this blog, we shall take a deeper look at atypical depression and shed light on some unknown facts.

What is Atypical Depression?

Atypical depression shares many of the typical symptoms of major depressive disorder or dysthymia. Individuals suffering from atypical depression can feel good momentarily due to some positive situations or happy moments, which is not observed in individuals suffering from typical depression.

Individuals suffering from atypical exhibit high levels of anxiety or experience reversed vegetative symptoms, such as sleeping too much (hypersomnia) and eating excessively (hyperphagia).

Studies have shown that females are four times more prone to develop atypical depression as compared to males.

Atypical depression tends to cause greater functional impairment than other forms of depression.

What is the Difference Between Typical and Atypical Depression?

The differences between typical and atypical depression lie primarily in their symptoms and in some cases, underlying biological factors.

The major symptoms of typical depression are:

  • Continuous sadness
  • Loss of interest
  • Insomnia
  • Significant weight loss/gain
  • Agitation
  • Suicidal thoughts

While the major symptoms of atypical depression are:

  • Mood reactivity
  • Increased appetite
  • Excessive sleeping
  • Leaden paralysis
  • Increased sensitivity
  • Fear of criticism

On a biological level, the difference between typical and atypical depression lies in the cause of each disorder. For example, atypical depression might be more closely linked to dysregulation in the hypothalamic-pituitary-adrenal (HPA) axis.

Understanding these distinctions can help in tailoring more effective treatment strategies for individuals experiencing these different forms of depression.

What Causes Atypical Depression?

This disorder can be caused by a combination of various factors such as – genetics, environment, or other psychological factors, etc.

Some of the causes are described down below:

  • Genetics- Having a family history of depression leads to increased chances of developing atypical depression.
  • Hormonal Changes- This is observed particularly in women. During pregnancy or menstruation, there are fluctuations in the levels of some hormones such as estrogen, progesterone, etc. This can often trigger depression.
  • Stress- Prolonged stress due to life situations, traumatic events, abuse, etc. can lead to the development of depression in such individuals.
  • Environmental factors- Living in a stressful or chaotic environment or facing social isolation can also lead to the onset of depression in some individuals.
  • Brain chemistry- Disbalance in neurotransmitter levels, such as serotonin, etc. results in depression as these neurotransmitters are responsible for mood control.
  • Personality- People with a highly sensitive nature or someone who can’t take criticism positively are more prone to atypical depression.
  • Medical Conditions- Chronic illnesses, medications, or substance abuse can facilitate the development of atypical depression.

Symptoms of Atypical Depression

The major symptoms of atypical depression are mentioned above. Here’s a more detailed overview of the symptoms.

  • Mood Reactivity- Individuals with atypical depression can experience mood improvements in response to positive events or circumstances. The moments are short-lived but people suffering from atypical depression can feel happiness owing to any positive event.
  • Increased Appetite & Weight Gain- This condition is known as hyperphagia. Individuals tend to crave more food when they develop atypical depression and overeat which leads to massive weight gain.
  • Hypersomnia- Sleeping more than usual, often more than 10 hours a day, and still feeling tired. Individuals might face difficulties staying awake even in the mornings and may feel tired all the time, even after enough sleep.
  • Leaden Paralysis- Feeling a heavy sensation in the body and finding it difficult to move. This physical heaviness contributes to overall fatigue and a lack of energy. The individual may feel that their limbs are weighted down and even small movements will tire them out.
  • Interpersonal Sensitivity- Individuals with atypical depression feel extreme sensitivity to rejection or criticism from others. This sensitivity can lead to significant distress and impairment in social and occupational functioning. This can lead the person to avoid social settings and distance themselves from others.

Do I have Atypical Depression?

Recognizing the symptoms of atypical depression is not an easy task. It requires paying close attention to specific symptoms and patterns that set it apart from typical depression. Here’s a detailed guide to identify if you are suffering from atypical depression.

You need to check for key symptoms, such as-

  • Mood Reactivity- Unlike typical depression, where the patient’s mood remains consistently low, those suffering from atypical depression experience mood improvement in response to positive situations or events.
    Signs- Keep a check on your mood and notice whether it lifts significantly after receiving good news, praise, or engaging in enjoyable activities.
  • Increased Appetite or Weight Gain- Atypical depression often leads to increased appetite which results in drastic weight gain in such individuals.
    Signs– Monitor any changes in your eating habits. Check if you are eating more frequently than you used to. Also, keep an eye on any signs of weight gain.
  • Hypersomnia- This symptom refers to excessive sleeping. An individual with atypical depression can feel sleepy all the time and can sleep for abnormally long periods.
    Signs- Track your sleep schedule. Check whether you’re sleeping for more than 9-10 hours and still feeling sleepy in the morning.
  • Leaden Paralysis- It makes an individual feel burdensome while making any movement. Hands and feet feel heavier than usual.
    Signs- Check if you feel uncomfortable while moving. Pay attention to physical sensations.
  • Sensitivity to Rejection- Individuals suffering from atypical depression experience heightened sensitivity to rejection or criticism, which can significantly impact their personal and professional lives.
    Signs- Reflect on your emotional responses. Check whether you feel excessively upset by minor criticism or rejections.

Why is Atypical Depression Hard to Diagnose?

Atypical depression is hard to diagnose due to several reasons, such as-

Overlap with Other Disorders

Symptoms of atypical depression, such as anxiety or somatic complaints, can overlap with those of other mental health conditions, such as anxiety disorders, personality disorders, or physical illnesses, making it difficult to distinguish and results in overlap.

Mood Reactivity

The ability of individuals with atypical depression to experience mood improvements in response to positive events can mask the underlying depressive state, leading to underreporting or misinterpretation of the severity of the condition.

Non-Typical Symptoms

Symptoms like hypersomnia (excessive sleeping) and hyperphagia (increased appetite) are opposite to the more commonly recognized symptoms of insomnia and loss of appetite in typical depression, which can lead to misdiagnosis.

Diagnostic Criteria

The diagnostic criteria for atypical depression can be less familiar to some healthcare providers, resulting in it being overlooked or misdiagnosed as another type of depression or mental health disorder.

Apart from these, often patients may not seek help for atypical depression and may present symptoms that are generally unrelated to depression, like – fatigue or other physical ailments. This leads the clinicians to focus on the symptoms rather than focusing on the underlying depression.

Treatment for Atypical Depression

Due to the differences in clinical presentation between atypical depression and melancholic depression, studies were conducted in the 1980s and 1990s. It reveals that treating atypical depression involves a combination of medication, psychotherapy, and lifestyle changes.

Medication for Atypical Depression

Antidepressants are a type of medication used for depression treatment. Antidepressants help in the treatment of Major Depressive Disorder, chronic pain, anxiety disorders, and addiction.

It should be noted that medications should only be consumed after being prescribed by a professional, as they are prescribed after considering other factors such as – health, severity of disorder, etc.

  • Monoamine Oxidase Inhibitors (MAOIs)- Before the year 2000, MAOIs were considered the most efficient antidepressant. But, due to unhealthy interactions with tyramine-rich food such as fava beans, certain types of wine, etc. now, they require dietary restrictions to avoid potentially dangerous interactions.
    Eg- Phenelzine (Nardil), Tranylcypromine (Parnate)
  • Selective Serotonin Reuptake Inhibitors (SSRIs)- This is one of the best medications for depression treatment at present. They have lower side effects than MAOIs and are most commonly prescribed.
    Eg- Fluoxetine (Prozac), Sertraline (Zoloft), and Citalopram (Celexa).
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)-
    These medications help increase the levels of serotonin and norepinephrine. Bupropion, a norepinephrine reuptake inhibitor is uniquely suited to treat the atypical depression symptoms of lethargy and increased appetite in most individuals. Other examples are – Venlafaxine (Effexor), and Duloxetine (Cymbalta).

Psychotherapy for Atypical Depression

  • Cognitive Behavioral Therapy (CBT)- CBT is one of the most effective forms of psychotherapy for depression. It focuses on identifying and changing negative thought patterns and behaviors that contribute to depressive symptoms. It helps individuals identify and challenge distorted thoughts and develop healthier ways of thinking. CBT involves cognitive restructuring – challenging and changing distorted thoughts, behavioral activation – increasing engagement in positive activities, and problem-solving. It is found to be very efficient in treating atypical depression.
  • Interpersonal Therapy (IPT)- Depression often arises due to issues in relationships and social roles. By addressing these issues, individuals can improve their mood and reduce symptoms. This can be achieved by undergoing IPT. IPT typically addresses four main areas: grief (complicated bereavement), role disputes (conflicts with significant others), role transitions (life changes), and interpersonal deficits (difficulty forming and maintaining relationships).
  • Dialectical Behavior Therapy (DBT)- It was originally developed for borderline personality disorder, but it has proved to be efficient in treating conditions like depression as well. DBT combines cognitive-behavioral techniques with mindfulness practices like mindfulness meditation to help individuals manage emotions and reduce self-destructive behaviors. DBT consists of four modules: mindfulness (focusing on the present moment), distress tolerance (coping with crises), emotion regulation (managing intense emotions), and interpersonal effectiveness (improving relationships).
  • Psychodynamic Therapy- This therapy focuses on exploring unconscious processes and past experiences that influence current behavior and emotions. The main goal of this therapy is to achieve emotional healing and insight. Psychodynamic therapy involves techniques like free association, dream analysis, and exploring past relationships. It may take longer than CBT or DBT but it provides long-lasting effects.
  • Humanistic Therapy- Humanistic approaches focus on helping individuals achieve their full potential and help them to realize their worth. Humanistic therapy emphasizes personal growth, self-acceptance, and finding meaning in life. The therapist provides a supportive environment that encourages self-exploration and self-discovery. It includes techniques like – active listening, empathy, and unconditional positive regard. It is a really helpful option for those individuals who suffer from self-esteem issues.
  • Combination Therapy- Sometimes, some individuals may exhibit symptoms that require a combination of therapies to resolve their issues. In such cases, the psychiatrist can combine various elements of a group of therapies and provide a tailored approach to the patient as needed. For example – a therapist might use CBT techniques to change negative thought patterns while incorporating mindfulness practices from DBT to help with emotion regulation.

Seeking Professional Help for Atypical Depression

It is essential to reach out to a professional healthcare worker such as a psychiatrist to receive assistance in getting rid of mental disorders. Regular sessions and consistent follow-ups are crucial for the effectiveness of psychotherapy.

Furthermore, seeking help is necessary to get diagnosed properly and accurately. A mental health professional can accurately diagnose whether an individual has atypical depression or another type of depression, ensuring that they receive the appropriate treatment.

Professionals provide a safe, non-judgmental space to explore your thoughts and feelings. They offer empathy and validation, which can be comforting and empowering, especially when dealing with depression.

One should not be ashamed to reach out for help as it is the only way they can get better.

Nutrients to Take During Atypical Depression

A healthy diet plays a huge role in managing atypical depression and caters to the overall health of a person.

Mentioned below are some foods and nutrients that can help support mental health and alleviate depressive symptoms. It would benefit an individual if he/she includes all the nutrients in their balanced diet.

Omega-3 Fatty Acids

Omega-3s are essential for brain health and have been shown to reduce symptoms of depression. Some rich sources are – Fatty fish (salmon, mackerel, sardines), flaxseeds, chia seeds, and walnuts.

Protein

Protein provides amino acids that are essential for the production of neurotransmitters like serotonin and dopamine. Lean meats such as -chicken, turkey; fish, eggs, dairy products, legumes, nuts, and seeds feature protein intake.

Complex Carbohydrates

Complex carbs help stabilize blood sugar levels and boost serotonin production, which can improve mood. Whole grains – brown rice, oats, quinoa; legumes, vegetables, and fruits are rich sources of complex carbohydrates.

Antioxidants

Antioxidants help protect the brain from oxidative stress and inflammation, which often causes depression in humans. Berries like blueberries, strawberries, blackberries; dark leafy greens – spinach, kale; nuts, seeds, and dark chocolate are good sources of antioxidants.

Vitamin- D

Vitamin D plays a role in mood regulation and has been associated with lower rates of depression. It has been found that people with lower exposure to sun rays are more prone to develop depression than others. The main sources of vitamin D are – fatty fish – salmon, mackerel; fortified dairy products, egg yolks, and exposure to sunlight.

Vitamin- B

Vitamins B-12 and B-9 (folate, or folic acid) help protect and maintain the nervous system, which includes the brain as well. The B vitamins help reduce the risk and symptoms of mood disorders, such as depression. The main sources of B vitamins are – eggs, meat, oysters, and milk.

Zinc

Zinc helps boost the overall immunity of an individual and helps lessen the effects of depression. Whole grains, oysters, beef, and chicken are some of the major sources of zinc. Other than these supplements are also available in medical stores.

Foods to Avoid

  • Sugary food and drinks- Large amounts of sugar can lead to blood sugar changes which in turn can lead to frequent mood swings which finally end up enhancing depression.
  • Processed food- Such food items often contain unhealthy fats and sugars which degrade one’s health and may cause depression.
  • Caffeine- Enhances insomnia in depressed individuals which can deteriorate their condition.
  • Alcohol- Enhances depression by interfering with bodily activities.

References

Virtual Psychiatrist
Fact Checked by
- Dr. Gundu Reddy
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