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In a 1998 study, Dr. Andrew A. Nierenberg, associate director of the depression clinical and research program at Massachusetts General Hospital, found that 42% of participants had atypical depression, 12% had melancholic depression, 14% had both depression subtypes and the rest had neither. The most important thing, he says, is getting a correct diagnosis so you can get the correct treatment.
What is Atypical Depression?
Sufferers of depression with atypical features will respond to negative or positive external events. They'll feel deeply depressed or somewhat hopeful depending on the latest situation they are faced with. Their mood will brighten considerably when dining out with friends or enjoying a good movie. But when they are alone, their mood will slip back into the dark depths of depression.
This type of depression usually follows an interpersonal rejection by a lover, boss, or close friend. People with atypical depression tend to overeat and oversleep, whereas people with melancholia often are characterized by weight loss and insomnia.
People with atypical depression feel paralyzed or too tired to get out of bed. Chocolate is particularly important as a comfort food.
Symptoms (in addition to typical symptoms of depression, the patient should have 2 out of 4)
- Increased appetite with weight gain of 10 lbs or more when depressed
- Hypersomnia (excessive sleep) of 10 hours or more per day or 2 hours more sleep than the usual amount of sleep when not depressed
- Heavy, leaden feelings in arms and legs
- Longstanding pattern of interpersonal rejection sensitivity, not limited to episodes of depression, that results in significant social or occupational impairment
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What Atypical Depression Is Like?
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Gillian remembers that her first bout of depression occurred in early adolescence. She states that her childhood was relatively normal and uneventful. It was marked only by her mother acting in ways that she now understands are symptoms of depression.
Gillian is now 48 and she states that she has been depressed since she was 13. She states that her feeling of depression will get better for a period and then worsen again. When they do get better, she is able to enjoy the pleasures of life. During the up times she will enjoy speaking to people, going out with her husband, and eating. She states that she especially enjoys going to good restaurants, where she will frequently overeat.
Gillian states that one of her worst traits is being late for appointments due to oversleeping. When her depression worsens, Gillian will experience a general lack of energy, show little or no initiative, and be overly sensitive to rejection by others. Gillian also reports that she is prone to panic attacks. These attacks first occurred in early adolescence and they continue to this day. She states that her level of anxiety has increased as she has gotten older.
Gillian is suffering from an atypical depression. This type of depression is very common in women. The symptoms of oversleeping, overeating, hypersensitivity to rejection (especially romantic rejection), and intermittent panic attacks, are characteristic of atypical depression. This type of depression usually begins in adolescence and, if untreated, will often continue throughout life.
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Treatment for Atypical Depression
Research shows that atypical depression is significantly more responsive to an MAOI in comparison with a tricyclic antidepressant. It also responds well to an SSRI. Patients usually prefer an SSRI vs. an MAOI because of the sometimes unpleasant side-effects associated with MAOIs.
Psychotherapy can also be useful. A 1999 study found that patients receiving cognitive behavioral therapy responded just as well as patients receiving the MAOI Nardil (phenelzine).
next: Psychotic Depression
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