Depression Health Center

Atypical Depression

Atypical depression is a type of depression that can have some symptoms that are similar to those of major depression, but it does not have the number of symptoms needed for a diagnosis of major depression. Common symptoms of atypical depression include increased appetite or weight gain, sleepiness or excessive sleep, and feeling extremely sensitive to rejection.

What is atypical depression?

Atypical depression is a type of depression with certain specific characteristics. A person with classic major depression has at least five of the following nine symptoms:

• sadness or depressed mood most of the day or almost every day
• loss of enjoyment in things that were once pleasurable
• major change in weight (gain or loss of more than 5% of weight within a month) or appetite 
• insomnia or excessive sleep almost every day
• physically restless or rundown that is noticeable by others
• fatigue or loss of energy almost every day
• feelings of hopelessness or worthlessness or excessive guilt almost every day
• problems with concentration or making decisions almost every day
• recurring thoughts of death or suicide, suicide plan, or suicide attempt

In general, people with atypical depression don't have as many of the symptoms that people with classical depression may have. They tend to have first experienced depression at an early age, during their teenage years.

Despite its name, atypical depression is probably rather common. Some doctors believe that it is underdiagnosed. 

What are the symptoms of atypical depression?

The main characteristic of atypical depression that distinguishes it from major depression is mood reactivity. In other words, the person with atypical depression will see his or her mood improve if something positive happens. In major depression, positive changes will not bring on a change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity:

• sleeping too much (hypersomnia)
• increased appetite or weight gain
• having a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationships
• having a feeling of being weighed down, paralyzed, or "leaden"

A doctor will investigate physical causes for any of these symptoms. That will include a physical exam and tests to look for a problem such as hypothyroidism. With hypothyroidism, having low levels of thyroid hormone can lead to symptoms that include depression and weight gain. 

What causes atypical depression?

Depression is believed to be the result of a chemical imbalance in the brain. These chemicals -- neurotransmitters that facilitate communication between brain cells -- include dopamine, serotonin, and norepinephrine. While the exact cause of depression is unknown, there are risk factors for depression, including:

• a family history of depression
• a significant loss -- from death, divorce, or separation -- that results in grief
• interpersonal conflicts and related emotions such as guilt
• any type of abuse -- physical, sexual, or emotional
• any type of major life event such as moving, changing or losing a job, graduating, retiring
• any type of serious illness such as cancer, heart disease, stroke, or HIV
• drug or alcohol abuse
• isolation or exclusion from family, friends, or other social groups

How is atypical depression treated?

Doctors are likely to recommend psychotherapy (talk therapy) and/or medications for atypical depression. There are different types of psychotherapy and medications available for treatment. You may be referred to a specialist such as a psychiatrist, psychologist, or other licensed professional for care.