When people hear the word “depression”, they usually assume that a person is sad all of the time, crying excessively, sleeping too much, or eating too little. They presume that a person is isolating, avoiding friends, and feeling poorly about their self-worth. With common depression, most of these assumptions are often true, as people experience extended and unrelenting bouts of sadness. However, with atypical depression, this is not exactly the case.
Atypical depression is a type of depression where people experience a reprieve from depressive symptoms when encountering a pleasurable moment. Pleasurable moments could result from compliments, from the receipt of sympathy, or from good news. These moments could happen as a result of a visit from a loved one, a phone call or social function with a friend, or other special activities or events. Regardless of the type of pleasurable moment, a person experiences a significant elevation in mood. Moods improve in direct relation to the good news or other positive events. “Atypical feature” is the specifier used and applied to major depression, bipolar disorder (when major depression is the most recent episode), or when atypical features are dominant during the most recent two years of dysthymic disorder.
Atypical depression is chronic, highly prevalent, has an early onset, and lasts longer than common depression. Atypical depression is the most frequently occurring type of depression and usually begins in adolescents or individuals in their early 20’s. Atypical depression is more likely to occur in women than men and in those with bipolar disorder, cyclothymia, or seasonal affective disorder.
Research has shown that atypical depression is commonly found in conjunction with bipolar disorder. Atypical depression carries an elevated risk of co-occurring anxiety and a higher risk of suicidal thoughts and behaviors. Atypical depression also has distinctive pathology pertaining to personality and biological characteristics.
The exact cause of atypical depression is unknown, but is believed to have a strong genetic component. Individuals with family members who have chronic atypical depression are more likely to have a genetic predisposition. Others causes may be due to abnormal neurotransmitters in the brain, which alters chemical messaging.
To be diagnosed with depression with atypical features, individuals must meet criteria outlined in the DSM-5. Along with mood reactivity to positive events, individuals must display at least two symptoms in the categories of enhanced appetite, increased sleep, heavy limb sensation, and sensitivity to interpersonal rejection that results in impairments. The final criterion for atypical depression is that the criteria cannot be met for melancholic or catatonic features of depression. Other features of atypical depression can include insomnia, eating disorders, negative body image, and headaches.
Due to symptoms of fatigue and rejection sensitivity, individuals can sometimes be misdiagnosed. Longstanding symptoms of rejection sensitivity can result in a misdiagnosis of personality disorder or neurosis, while chronic symptoms of fatigue can result in a misdiagnosis of chronic fatigue syndrome. Atypical depression should also be used as a marker for bipolar disorder to assist with early diagnosis and prevent against misdiagnosis.
Treatment for atypical depression includes medication and psychotherapy. Antidepressants are the most common types of medication used to treat atypical depression. Therapeutic interventions seek to help people to improve coping, to recognize and change unhealthy thought patterns and behaviors, and to improve interpersonal relationships.
Although the term of depression is most often linked to the image of a person under the covers in a dark room for months on end, this may not always be the case. Perhaps this person has an atypical specifier to their depression, where they experience moments of pure joy in response to happy moments, thus providing a brief respite from their symptoms.
Tracy is a Licensed Professional Counselor and is a clinical supervisor for the Community YMCA, Counseling & Social Services branch. Tracy has over 12 years of experience working in many settings including partial care hospitalization and intensive outpatient programs, community agencies, group practice, and school-based programs. Tracy works with clients of all ages, but especially enjoys working with the adolescents. Tracy facilitates groups using art therapy, sand play and psychodrama.