Overview of Atypical Depression

Atypical depression is a type of depression that does not follow what is considered a “typical” manifestation of the disease. Generally speaking, patients with atypical depression have similar symptoms to patients with major depressive disorder (MDD), but there is one key difference: emotional response. In other words, if something positive happens, a person’s mood will improve.

Atypical depression, now called major depression with atypical features, is actually quite common. Unlike other forms of depression, patients with atypical depression may respond better to an antidepressant called a monoamine oxidase inhibitor (MAOI). MDD with atypical symptoms also has an earlier age of onset and is usually diagnosed in adolescence.


In addition to the core symptoms of depression, patients with atypical depression may also experience the following symptoms:

  • After a positive event or good news, the mood improves temporarily
  • Increased appetite and weight gain
  • A feeling of heaviness in the arms or legs
  • Body aches
  • Prolonged sleep at night or during the day (too much sleep)
  • Extremely sensitive to rejection or perceptual criticism

Less common symptoms include:

  • Insomnia
  • Headache
  • Eating disorder
  • Poor body image


The reason why some people experience atypical depression is unclear. A potential cause of atypical depression is an imbalance of certain neurotransmitters, including dopamine, serotonin, and norepinephrine, all of which affect mood.

Other factors that may increase the risk of atypical depression include:

  • family history. If your family members also have depression or other types of mood disorders, you are more likely to have symptoms of atypical depression.
  • Certain medical conditions. If you have a history of bipolar disorder, anxiety, avoidant personality, body deformity, or social phobia, you may be more likely to have atypical depression.
  • Material use. A history of substance use also increases the likelihood of depression.
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Making the right diagnosis is a key step in getting the treatment you or your loved one needs. Unfortunately, unlike many other health conditions, no laboratory tests, X-rays, or physical exams can provide a definitive diagnosis. Instead, your doctor needs to make a clinical diagnosis that takes into account your family history, risk factors, symptoms, and any underlying health problems.

To rule out any health conditions that may cause depression symptoms or underlying causes, you may undergo blood tests, drug screenings, and imaging tests (such as brain CT scans or MRI).

You may also receive a depression test, which can be done verbally by a doctor or mental health professional during the exam, or through a paper or digital device before seeing a doctor.Some doctors compare your answers and symptoms with Manual of Diagnosis and Statistics of Mental Disorders (DSM-5)-but this is only part of the diagnostic puzzle.

According to DSM-5, to be diagnosed with atypical symptoms of depression, a person must show the ability to respond to positive life events (emotional responses) and temporarily feel better, plus any two of the following criteria For a period of two or more weeks:

  • Binge eating or weight gain
  • Too much sleep
  • Fatigue, weakness, and the feeling of “overwhelmed”
  • Strong sensitivity to rejection
  • Strongly reacting emotions


Although selective serotonin reuptake inhibitors (SSRIs) and other newer drugs are usually the first-line treatment of depression due to their favorable side effects, patients with atypical depression tend to respond better to monoamine oxidase inhibitors (MAOIs) .

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Some common MAOIs include:

  • Nardil (phenelzine)
  • Parnate (Tranylcypromine)
  • Maplan (Isocarbazide)
  • Emsam (Selegiline)

Nevertheless, SSRIs may be prescribed first because they do not have the possibility of serious side effects or dietary restrictions like MAOIs. For example, to prevent potentially fatal spikes in high blood pressure, it is necessary to avoid tyramine-rich foods and beverages while taking MAOI.

Wellbutrin ((bupropion)) is another medicine used to treat atypical depression and is usually prescribed with other antidepressants to help combat any sexual side effects found in these drugs.

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

CBT can help you develop coping skills to better manage stress, deal with negative thoughts and emotions, and manage your fears. These skills are especially useful when you are waiting for antidepressants to start working.

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

  • Behavior Therapy
  • Cognitive Therapy
  • Dialectical Behavior Therapy
  • Individual, group and family therapy
  • Interpersonal Therapy
  • Psychodynamic therapy

In addition to medication and psychotherapy, the treatment of atypical depression may also include 30 to 45 minutes of light therapy (phototherapy) every morning, using a light box with a minimum rated power of 10,000 lux.


If atypical depression interferes with your daily activities, working with your doctor to develop a treatment plan involving medication and psychotherapy is a good first step. In addition, lifestyle changes may help relieve symptoms and help you cope better.

  • Prioritize nutrition and exercise. Doing your best to adhere to a healthy diet and regular exercise program will improve your overall health and help reduce the symptoms of atypical depression. Exercise five days a week, 30-60 minutes a day.
  • Practice mindfulness meditation and deep breathing. The combination of deep breathing exercises and mindfulness meditation can teach you to be aware of your thoughts and feelings without reacting to them.
  • Write it in the diary. Diary or expressive writing is a highly recommended tool for dealing with depression. Whether you do this every day or every week, getting into the habit of keeping a journal can help you explore your feelings and counteract the many negative effects of stress.
  • Seek support. To cope with depression and prevent isolation, the most important thing you can do may be to get strong social support. This can include trusted family and friends, or an online or face-to-face depression support group with whom you can contact and share your feelings and experiences.

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It is important to see a mental health professional and not your primary care doctor for treatment. Not all types of depression are the same, and they do not respond to the same medications. Doctors in general practice are unlikely to have the necessary experience to distinguish between subtypes or to know which treatment options are more likely to work.

If you are forced to see a primary care doctor for treatment due to insurance or financial conditions, please run more errands to make up for the potential lack of knowledge of your doctor. If you teach yourself and play an active role in treatment, you are unlikely to pass the diagnosis crack.


Overview of Atypical Depression
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