Causes and Symptoms of Atypical Depression

Atypical depression is actually the most common subtype of depression in outpatients, according to Andrew Nierenberg MD, Associate Director of the Depression and Clinical Research Program at Massachusetts General Hospital, affecting anywhere from 25 to 42 percent of the depressed population.

According to the DSM-IV, as opposed to major depression, the patient with atypical features experiences mood reactivity, with improved mood when something good happens. In addition, the DSM-IV mandates at least two of the following: increase in appetite or weight gain (as opposed to the reduced appetite or weight loss of "typical" depression); excessive sleeping (as opposed to insomnia); leaden paralysis; and sensitivity to rejection.

A study by Agosti and Stewart published in the Journal of Affective Disorders in 2001 found that patients with atypical depression experienced greater functional impairment than their non-atypical counterparts, as well as exhibiting more interpersonal sensitivity, more chronic dysphoria, and more bipolar II disorder. Women comprised 70 percent of the study population of those with atypical depression.

A study by Posternak and Zimmerman published in Psychiatry Research in 2001 cast doubt on the only feature of atypical depression that is mandatory under the DSM - that of mood reactivity. In their study, the authors evaluated the five symptoms of atypical depression across five different groups of patients (including women, different age groups, and according to severity and length of time of symptoms), and discovered mood reactivity only featured among the women patients, suggesting this particular criteria should be dropped.

The same study also found at best a limited association between the five atypical features among the five clinical profiles. Women, for instance, consistently displayed four of the five symptoms for atypical depression while patients under age 30 exhibited only one. Two patients, then, may have two different sets of symptoms, which suggests there is nothing typical about atypical depression.

A multi-center study identified a group with atypical depression, representing 36.4 percent of the depressed sample in the US National Comorbidity Survey. The study found that those with atypical depression were mostly women, had higher rates of depressive symptoms, more co-occurring psychiatric illnesses, more suicidal thoughts and attempts, greater disability and restricted activity days, more use of some healthcare services, greater paternal depression, and more childhood neglect and sexual abuse.

Atypical depression is not new. Indeed, it is one of the most common kinds of depression. The name atypical depression comes from the fact many of its symptoms are opposite to those of some severe depressions. If you have atypical depression, you may feel as though your body is so heavy you can’t lift your head or walk.

Experts have linked atypical depression to other psychiatric problems such as borderline personality disorder, but only a professional can diagnose you with having atypical depression. Atypical depression may occur together with panic disorder. Many people with atypical depression abuse drugs or alcohol.
People with atypical depression are externally validated. They feel good when people give them positive compliments and they feel bad when someone criticizes them. Their moods change and shift as quickly as the wind depending if they are isolated and lonely or with a group of friends enjoying a night out on the town.

Symptoms of atypical depression:

  • Sleeping more than 10 hours (hypersomnia).
  • Cyclical depressive mood.
  • Emotional sensitivity to criticism and rejection.
  • Leaden paralysis (i.e., heavy, leaden feelings in arms or legs).
  • Feelings of lethargy and emotional paralysis.
  • Increased appetite and food cravings for carbohydrates (comfort eating).
The exact reason of atypical depression is still unknown. Still doctors believe that genes and environment has something to do with this form of depression. Here are some of the possible causes of atypical depression:

  • High blood pressure and higher level of cholesterol.
  • Sleeping disturbances.
  • Stress; especially due to the loss of friends or loved ones, or those things that you love the most.
  • Family history of depression because of genetic factors.
  • Mental, physical or sexual abuse that happened in the past.
  • Intake of Alcohol or drugs; it is proved that more than 20% drug addicts suffer from depression.
  • Nutritional deficiencies.
  • Nutrition problems at childhood stage.
  • Too much or very little exposure to light is also a major factor that contributes to atypical depression.
  • Certain medications, including those for high blood pressure, high cholesterol, or irregular heartbeat.
Remember that if you have light forms of atypical depression, you are at higher risk for more serious and sudden major depression. You may not even know you have atypical depression because you feel depressed most of the time. You may try to hide your symptoms of atypical depression by working harder, going on diets, analyzing your failed relationships and staying on a rigid schedule; however, you have only covered up your atypical depression not cured it.

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