Depression is one of the most common mental disorders, but not all cases of depression are alike. While “typical” depression might be characterized by low energy, loss of appetite, or persistent sadness regardless of circumstances, some cases of depression involve different symptoms.

Atypical depression is less common than major depressive disorder, but still represents a considerable number of cases of depression. Although it shares common features with typical depression, atypical depression includes some unique signs and symptoms.

What Is Atypical Depression?

Atypical depression is a subtype of major depressive disorder characterized by several symptoms out of line with those of typical depression. Atypical depression is a separate diagnosis from typical depression and was discovered based on patients with different symptoms who responded better to specific medications. 

When comparing atypical vs. typical depression, people with atypical depression are able to temporarily feel better in response to good news or a happy event, and may also have unusual symptoms related to sleep and appetite. It’s estimated that around 40% of people with major depression or dysthymia meet criteria for atypical depression.

Symptoms of Atypical Depression

There are several symptoms that help differentiate between typical and atypical depression. For example, atypical depression symptoms include:

  • Mood reactivity, or the ability to brighten in response to something good
  • A significant increase in appetite or weight gain
  • Excessive daytime sleeping
  • Feeling heavy or paralyzed in the arms and/or legs
  • Extreme sensitivity to rejection or interpersonal conflict

These symptoms are notably different from typical depression, which is characterized by persistent low mood, decrease in appetite and reduced sleep. Some sufferers of atypical depression suggest that they have experienced many of these symptoms all of their lives and that they can be significantly impairing. 

The symptoms of atypical depression share similarities with symptoms of bipolar disorder, certain personality disorders, and chronic fatigue syndrome. Because of this, atypical depression may sometimes be misdiagnosed or require further investigation to ensure the correct diagnosis.

What Causes Atypical Depression?

Atypical depression can be part of different types of mood disorders, including bipolar disorder or dysthymia. Because atypical depression can be related to many types of mood disorders, the causes and underlying risk factors may vary. 

The answer to what causes atypical depression is not straightforward. As with many mental disorders, atypical depression is likely caused by a combination of genetic, personal and environmental risk factors.

More specifically, the causes of atypical depression have been linked to having a family history of the condition, as well as some biological differences in brain function. In combination, the personality trait of being sensitive to rejection is a key feature of atypical depression.

Other factors related to atypical depression include being female, having a higher body mass index, metabolic syndrome and abnormally low blood levels of cortisol. However, it’s hard to know whether these are causes or side effects of atypical depression.

Diagnosing Atypical Depression

An atypical depression diagnosis relies on the presence of several unique criteria. As presented in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) for atypical depression, a diagnosis of the condition requires the presence of mood reactivity (the ability to brighten) as well as at least two other symptoms including increased appetite or weight gain, excessive sleep, leaden paralysis and long-term sensitivity to rejection. 

While there is no clear or simple test for atypical depression, diagnostic criteria are clearly outlined in the DSM-V. 

How Is Atypical Depression Treated?

Atypical depression treatment usually has a slightly different strategy and prognosis than typical depression treatment. Medication is one common treatment approach for atypical depression. Initially, research suggested that atypical depression had a better response to medication monoamine oxidase inhibitors than selective serotonin-reuptake inhibitors (two types of antidepressant medications). However, further research has shown that the difference in response to medication is actually very small.

Another common atypical depression treatment option is cognitive-behavioral therapy. Interestingly, treatment response for atypical depression can also be improved with regular exercise.

Although atypical depression can often occur at the same time as other mental health conditions, rates of remission are typically higher than those associated with typical depression. In the end, the best treatment strategy will depend on the individual, the severity of illness and any co-occurring conditions present. If you or someone you love is suffering from atypical depression and a related substance use disorder, contact The Recovery Village today to discuss treatment options.