Atypical Depression

Normally, a depressive episode makes you feel hopeless, but this one makes you feel high. However, there are some temperamental characteristics present in those with atypical depression, including the propensity to expect failure, ruminating with high anticipatory worry, difficulty getting over humiliation and embarrassment, giving up easily out of frustration, great sensitivity to criticism, underachievement (poor persistence), and propensity to talk about feelings and experiences (high attachment).

What is Depression?

Depression is characterized by extreme sadness and despair. While feeling sad is a natural feeling, severe depression is not. Nobody has pinpointed the precise moment when "feeling down or blue" turns into depression. Depression is a mood or a clinical illness that combines symptoms of the emotional, cognitive, and behavioral forms.

What is Atypical Depression?

Atypical depression, also called depression with atypical features, is a distinct subtype of depression that includes rejection sensitivity. This type of depression is more tied to the person's environment and situation. Females are disproportionately more likely than males to have atypical features, to begin showing them sooner than average, and to be more prone to express suicidal thoughts.

History of Atypical Depression

In 1959, West and Dally offered the first definition of A.D. as a preferential monoamine oxidase inhibitor (MAOI)−responsive depression. Before that, in 1948, the term "atypical depression" was used to refer to depressed individuals who also displayed agitation, paranoid characteristics, and bewilderment and responded favorably to electroconvulsive therapy (ECT). The DSM−III adopted the term to describe depression. Two forms of A.D. were proposed by Davidson et al. in 1982: type A, characterized by a predominance of anxiety symptoms, and type V, characterized by vegetative symptoms such as hyperphagia, weight gain, excessive sleeping, and increased sexual urge. Both categories shared traits such as early onset, female dominance, outpatient dominance, mildness, and a modest suicide attempt rate. The DSM−IV included the "atypical features" criteria as a specifier for major depression and dysthymia in 1994.

Diagnostic Criteria

Reactivity to mood, i.e., the mood brightens in response to actual or potential positive events (e.g., a visit from children and compliments from others). If the external conditions remain positive, the mood may become euthymic (not depressed) even for prolonged durations. Two (or more) of the traits must be present −

  • A notable increase in weight or appetite.

  • Hypersomnia. An extended amount of nightly sleep or daytime naps that add up to at least 10 hours of sleep per day are both examples of hypersomnia (or at least 2 hours more than when not depressed).

  • Leaden paralysis (i.e., heaviness or leadenness in the arms or legs). This sensation often lasts at least an hour each day, although it can even last for many hours.

  • A persistent pattern of interpersonal rejection sensitivity significantly impairs social or professional functioning (not only during episodes of mood distress). Unlike the other atypical characteristics, pathological sensitivity to perceived interpersonal rejection is a trait that develops early in life and lasts throughout the majority of adulthood. Rejection sensitivity can be present whether a person is sad or not, though it may be worsened during depressive episodes.

The criteria for "with melancholic features" or "with catatonia" should not meet during the same episode.

How is Atypical Depression different from Major Depression?

Atypical depression differs from major depression in that a person with A.D. will get momentary relief when a happy life event occurs. However, a person with major depression will almost always feel down.

How is Atypical Depression different from Melancholic Depression?

In Atypical Depression, Leaden Paralysis is present, while in Melancholic Depression, psychomotor agitation or retardation is present. People with A.D. experiences excessive sleep while those with M.D. experience a lack of sleep.


Despite multiple pharmacological trials, there are currently no detailed treatment recommendations for A.D. A combination of psychotherapy and medications is the cornerstone of treatment for atypical depression. Psychotherapy can assist someone in processing their feelings, feeling less alone, and creating coping mechanisms for depressing thoughts. Medications used to treat A.D. include antidepressants, mood stabilizers, and antipsychotics. The first class of antidepressant drugs, known as monoamine oxidase inhibitors (MAOIs), were created in the 1950s and work by preventing the function of monoamine oxidase. This enzyme breaks down norepinephrine and serotonin after they have been produced. The MAOIs have the same potential for treating depression as other drugs. However, they have potentially harmful (even deadly) effects if specific foods high in the amino acid tyramine are taken. As a result, they are rarely used today to treat other types of depression until other types of treatment have failed. The only subtype of depression that appears to react preferentially to MAOIs is depression with atypical features.


Typically, the word "atypical" refers to something rare. Atypical depression, while distinct in its appearance, is most definitely not rare among depressive disorders. Atypical depression's status is challenging regardless of whether it is a disorder or a collection of symptoms. If there are multiple types of depression and at least one typical manifestation (e.g., melancholia), atypical depression may reflect diverse residual conditions.