Atypical depression
Encyclopedia
Atypical depression is a subtype of dysthymia and major depression, sharing many of the symptoms of both, but also being characterized by mood reactivity—being able to experience improved mood in response to positive events. In contrast, sufferers of "melancholic" depression
generally cannot experience positive moods, even when good things happen. Additionally, atypical depression is characterized by reversed vegetative symptoms
, namely over-eating and over-sleeping, and separately by interpersonal rejection sensitivity.
"Hysteroid dysphoria
" has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors.
Despite its name, "atypical" depression is actually the most common subtype of depression—up to 40% of the depressed population may be classified as having atypical depression.
a) Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
b) At least two of the following:
c) Criteria are not met for Melancholic Depression
or Catatonic
Depression during the same episode.
, social phobia
, avoidant personality disorder
, or body dysmorphic disorder
.
Recent research suggests that females are more likely to be affected by atypical depression than males, and that young people are more likely to suffer from hypersomnia
while older people are more likely to suffer from polyphagia
.
Medication response differs between chronic atypical depression and acute melancholic depression
. Some studies suggest that an older class of drugs, the monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs are usually quite effective in this illness, the tricyclic antidepressant
s typically are not.
In addition, SSRI responses can often be enhanced with "booster" medications, and medication regimens seem to work best when combined with appropriate psychotherapy. It is important to remember that such co-morbid syndromes as panic disorder
may not be fully treated without additional medication(s).
It has been noted that patients with atypical depression often suffer from intense cravings for carbohydrate
s. A mineral supplement, chromium picolinate, was found to assuage these cravings. It also was found to have an antidepressant effect on some atypical depression sufferers.
Some hypothesize that atypical depression may be related to thyroid dysregulation. Some studies have found subtle thyroid
abnormalities in people with atypical depression. Another study suggests that patients may benefit from triiodothyronine
, a medication used to treat hypothyroidism
.
Melancholic depression
Melancholic depression, or 'depression with melancholic features' is a subtype of major depression characterized by major depressive disorder with the following specific features: anhedonia , severe weight loss, psychomotor agitation or retardation, insomnia with early morning awakenings, guilt...
generally cannot experience positive moods, even when good things happen. Additionally, atypical depression is characterized by reversed vegetative symptoms
Reversed vegetative symptoms
Reversed vegetative symptoms include only oversleeping and overeating , as compared to insomnia and loss of appetite . These features are characteristic of atypical depression ....
, namely over-eating and over-sleeping, and separately by interpersonal rejection sensitivity.
"Hysteroid dysphoria
Hysteroid dysphoria
Hysteroid dysphoria is a name given to repeated episodes of depressed mood in response to feeling rejected, and a craving for sweets, especially chocolate....
" has been described in outpatient populations and is thought to be a subtype of atypical depression involving rejection sensitivity and therapeutic response to monoamine oxidase inhibitors.
Despite its name, "atypical" depression is actually the most common subtype of depression—up to 40% of the depressed population may be classified as having atypical depression.
Symptoms
The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive Disorder with Atypical Features, characterized by:a) Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
b) At least two of the following:
- Significant weight gain or increase in appetite;
- Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression);
- Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
- Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.
c) Criteria are not met for Melancholic Depression
Melancholic depression
Melancholic depression, or 'depression with melancholic features' is a subtype of major depression characterized by major depressive disorder with the following specific features: anhedonia , severe weight loss, psychomotor agitation or retardation, insomnia with early morning awakenings, guilt...
or Catatonic
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
Depression during the same episode.
Research
In general, atypical depression tends to cause greater functional impairment than other forms of depression. Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression — usually beginning in the teenage years. Similarly, patients with atypical depression are more likely to suffer from other psychiatric syndromes such as panic disorderPanic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
, social phobia
Social anxiety disorder
Social anxiety disorder , also known as social phobia, is an anxiety disorder characterized by intense fear in social situations causing considerable distress and impaired ability to function in at least some parts of daily life...
, avoidant personality disorder
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...
, or body dysmorphic disorder
Body dysmorphic disorder
Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...
.
Recent research suggests that females are more likely to be affected by atypical depression than males, and that young people are more likely to suffer from hypersomnia
Hypersomnia
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.There are two main categories of hypersomnia: primary hypersomnia and recurrent hypersomnia...
while older people are more likely to suffer from polyphagia
Polyphagia
Polyphagia means "eating too much". It derives from the Greek words πολύς which means "very much", and φαγῶ , verb for "I eat"....
.
Medication response differs between chronic atypical depression and acute melancholic depression
Melancholic depression
Melancholic depression, or 'depression with melancholic features' is a subtype of major depression characterized by major depressive disorder with the following specific features: anhedonia , severe weight loss, psychomotor agitation or retardation, insomnia with early morning awakenings, guilt...
. Some studies suggest that an older class of drugs, the monoamine oxidase inhibitors (MAOIs), may be more effective at treating atypical depression. While the more modern SSRIs are usually quite effective in this illness, the tricyclic antidepressant
Tricyclic antidepressant
Tricyclic antidepressants are heterocyclic chemical compounds used primarily as antidepressants. The TCAs were first discovered in the early 1950s and were subsequently introduced later in the decade; they are named after their chemical structure, which contains three rings of atoms...
s typically are not.
In addition, SSRI responses can often be enhanced with "booster" medications, and medication regimens seem to work best when combined with appropriate psychotherapy. It is important to remember that such co-morbid syndromes as panic disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
may not be fully treated without additional medication(s).
It has been noted that patients with atypical depression often suffer from intense cravings for carbohydrate
Carbohydrate
A carbohydrate is an organic compound with the empirical formula ; that is, consists only of carbon, hydrogen, and oxygen, with a hydrogen:oxygen atom ratio of 2:1 . However, there are exceptions to this. One common example would be deoxyribose, a component of DNA, which has the empirical...
s. A mineral supplement, chromium picolinate, was found to assuage these cravings. It also was found to have an antidepressant effect on some atypical depression sufferers.
Some hypothesize that atypical depression may be related to thyroid dysregulation. Some studies have found subtle thyroid
Thyroid
The thyroid gland or simply, the thyroid , in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage...
abnormalities in people with atypical depression. Another study suggests that patients may benefit from triiodothyronine
Triiodothyronine
Triiodothyronine, C15H12I3NO4, also known as T3, is a thyroid hormone. It affects almost every physiological process in the body, including growth and development, metabolism, body temperature, and heart rate....
, a medication used to treat hypothyroidism
Hypothyroidism
Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
.