Having depression can be a heavy and constant struggle, creating a dark cloud that dampens our mood, energy, and outlook on life.
What many people do not recognize is that not all forms of depression require us to feel sad all the time.
Atypical depression masks this sadness on occasion, loosening its grip and making room for happiness, joy, and cheerfulness. However, this moment tends to be fleeting, as the sadness creeps back in and the regular symptoms of depression persist.
Similar to other forms of depression, symptom management and treatment are possible!
Read on as we uncover the signs and symptoms of atypical depression, explore effective treatment options, and provide strategies to help manage and improve your overall mental well-being.
What is atypical depression?
Atypical depression (AD) is defined as a subtype of major depressive disorder, where all but one symptom aligns. The defining ‘atypical feature’ is a temporary mood improvement as a result of a positive life event.
However, this feeling tends to fade, and longer, more persistent periods of low mood and sadness take over.
Like carrying a backpack filled with heavy rocks, atypical depression shows itself as someone takes out a couple of heavy rocks. Just when you think the day is a little brighter, the weight is a lighter lighter, they put the rocks back again, making every step as difficult as before.
AD affects 15-36% of people with some type of depressive disorder.
Symptoms of atypical depression
Though atypical depression is not necessarily ‘uncommon’ it is simply different from the more typical forms. In other words, both typical and atypical depression involve persistent feelings of hopelessness and sadness; the major difference lies in the temporary relief of heavy emotions.
People with atypical depression have two or more of the following symptoms:
- Mood reactivity (i.e. relief of sadness)
- Excessive sleepiness or fatigue (hypersomnia)
- Increased appetite and/or weight gain
- Higher sensitivity to rejection or criticism
- Heaviness of the limbs (leaden paralysis)
Individuals with AD may also have other mental health challenges, including anxiety disorder (i.e. social phobia), eating disorders, and substance-related disorders.
Overlapping depressive symptoms
Research relates it to a common part of bipolar disorder, sharing many of the characteristics of someone with bipolar disorder II or “soft” bipolar spectrum disorder.
A recent 2023 study notes that melancholia is a form of depression characterized by deep sadness, loss of interest in nearly everything, and major psychomotor disturbances (trouble moving and thinking).
Causes and risk factors
Learning the underlying causes or risk factors associated with AD is a necessary first step to understanding its impact and developing an effective treatment plan.
Biological factors
Though the exact cause of atypical depression is not fully understood, certain biological factors are seen in individuals with this condition.
Factors are common in depressive symptoms include:
- Neurotransmitter imbalances: Impaired functioning of serotonin, dopamine, and noradrenaline is thought to disrupt mood regulation and contribute to the development of AD.
- Genetics: A family history of mood disorders, such as persistent depressive disorder (PDD) or bipolar disorder, suggests a hereditary link that may increase the risk of developing AD.
- Hormonal changes: Dysregulation in certain hormones, such as leptin (a fat-derived hormone), may play a role in increasing the risk of AD.
Overall, many of these biological factors can collectively or individually contribute to the development and persistence of this condition.
Psychological factors
Our mental and emotional processes are another contributing factor in the development of atypical depression. Some common factors include:
- Personality traits: Individuals with higher sensitivity to interpersonal stress, such as anticipating rejection and failure often characteristic of avoidant personality, is seen as a risk factor for atypical depression.
- History of trauma or abuse: Being exposed to childhood trauma or any type of abuse (i.e. physical, sexual, or emotional) exposes individuals to an increased risk of atypical depression.
- Chronic stress: Prolonged stress contributes to an increased risk of AD as a result of neuroinflammation leading to disruptions in our neurotransmitter response.
Though many of these psychological factors are out of our control, addressing them through therapy and supportive interventions can help manage symptoms and improve mental health outcomes.
Environmental factors
Our physical environment, including where we live and the people we surround ourselves with, can take a toll on our mental health.
Some common environmental factors linked to atypical depression include:
- Social and relationship difficulties: Atypical depression is associated with higher instances of social anxiety, which can impair our interpersonal relationships, creating stress and emotional strain.
- Lack of social support: Similar to most forms of depression, not having a strong network of friends and family members can make it harder to cope with challenges and contribute to or worsen feelings of loneliness and isolation.
- Poor living conditions: Exposure to environmental stressors, such as unsafe neighborhoods or overcrowded/unsanitary housing, can further deteriorate one’s mental health and increase the risk of AD.
Our environment can create a ton added stressors while also limiting resources for coping and recovery. Finding support is not only necessary but may also be crucial for managing and overcoming these challenges.
Diagnosing atypical depression
Atypical depression can often be misdiagnosed as certain personality disorders, like borderline disorder or avoidant personality disorder, due to its unique symptoms and overlap with other mental health conditions.
This is why clinical assessments are done by a psychiatrist or clinical psychologist to accurately diagnose atypical depression.
Clinical assessment
Getting an accurate diagnosis of atypical depression requires the use of appropriate diagnostic criteria. Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to determine whether or not an individual meets the specific criteria for AD.
Following this step, there are a number of psychological evaluations and questionnaires used to gain insight into an individual’s symptom expression, medical history, and overall functioning.
Common clinical interviews, questionnaires, or self-reported scales used include:
- Mini International Neuropsychiatric Interview (MINI): Gathers information regarding symptoms and history
- Beck Depression Interview (BDI): Assesses depressive symptoms severity
- Hamilton Depression Rating Scale (HDRS): Measures severity based on clinician-rated assessments
- Mood Disorder Questionnaire (MDQ): Screens for mood disorders to identify manic or hypomanic symptoms that may overlap with AD
- Inventory of Depressive Symptomatology (IDS): Evaluates symptoms to distinguish AD from other forms of depression
A careful assessment and intake process is essential to ensure that all potential diagnoses are considered and ruled out, and to create a clear path for identifying the most effective and tailored treatment plan.
Treatment options for atypical depression
As individual as depression is, atypical depression is no different. For this reason, having a multifaceted approach to address atypical depression more comprehensively is shown to be the most effective.
There are four main avenues that many clinicians recommend for treating atypical depression: psychotherapy (talk therapy), medications, lifestyle changes, and alternative treatments.
Psychotherapy
Talk therapy is a common treatment for individuals struggling with atypical depression. Psychotherapy can offer support, guidance, and education to help individuals alleviate symptoms of depression while also improving their sense of control, function, and well-being.
Therapeutic modalities used to treat AD include:
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a therapeutic modality used for many forms of depression, including atypical depression. Consider CBT as a type of ‘mental toolkit’ that helps target and challenge negative thoughts and looks to break free from this sort of self-defeating pattern.
Since self-criticism and pervasive sadness are both common with AD, this approach can relieve these symptoms and foster a more balanced perspective.
Interpersonal therapy
Since atypical depression can interfere with our social abilities, focusing on interpersonal dynamics and communication can appropriately address these challenges, build supportive networks, and reduce feelings of isolation.
Interpersonal Therapy (IPT) acts more as a social compass, helping individuals navigate and improve their interpersonal relationships with more confidence. It is also beneficial for addressing cases of severe social anxiety.
Psychodynamic therapy
When it comes to atypical depression, there are plenty of emotions and sudden changes in emotions that can create confusion and distress.
Consider psychodynamic therapy as a deep dive into the emotional undercurrents that cause these changes. It works by helping individuals uncover, understand, and address the root causes of emotional instability through an exploration of past experiences and unconscious processes.
Medication
Medication options for atypical depression often include antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs).
While the benefits of many antidepressant medications include, symptom relief, improved mood and energy levels, and better cognition, there are certain side effects to consider. This may include changes in weight, insomnia, sexual dysfunction, and even increased risk of suicidal ideations.
Other common options related to AD include mood stabilizers or antipsychotic medication to help manage mood fluctuations and address severe or treatment-resistant symptoms.
Since there is no single ‘best’ option available as everyone has an individual response to various medication options, it is best to consult with your doctor, psychiatrist, or nurse practitioner for more information.
Lifestyle modifications
For more immediate symptom management, changing our lifestyle (even slightly) can be incredibly helpful.
Some examples of practical lifestyle changes include:
- Adopting healthier eating habits: Avoiding foods with high inflammatory responses, such as junk food or fast foods, and instead incorporating more fruits, vegetables, lean meats and grains can reduce the risk of depressive symptoms
- Exercising on a daily basis: Moving your body every day, such as jogging, yoga, or strength training has been shown to reduce symptoms of depression in most individuals
- Committing to better sleep hygiene practices: Maintaining a consistent sleep schedule, limiting screen time before bed, and avoiding caffeine late at night can all improve your sleep practices and lead to better mental health outcomes
- Practice stress management techniques: Stress relieving exercises may range from practicing mindfulness or meditation to deep breathing or journaling
Sometimes, even the smallest changes in our day to day can have a profound impact on our mental health and well-being.
Alternative and complementary treatments
For those looking for non-traditional strategies, there are also alternative approaches and complementary treatments that can provide relief from symptoms of atypical depression.
Herbal supplements have gained popularity as natural remedies for depression. For instance, the Mayo Clinic reports on several studies that support the therapeutic benefits of St. John’s Wort for treating mild to moderate depression. These studies suggest that St. John’s Wort can be as effective as several antidepressant medications for some individuals.
Acupuncture is another alternative therapeutic option for managing depression. According to a 2019 study, acupuncture is shown to help influence neurotransmitter levels, such as serotonin and noradrenaline, which both directly impact mood and energy levels.
How therapy can help
Therapy is a critical component in the management and treatment of atypical depression. It provides a structured environment where individuals can explore their thoughts, feelings, and behaviors with the support of a trained mental health professional.
The role of mental health professionals
Psychologists, psychiatrists, and other mental health professionals including counselors and social workers each play a central role in treating atypical depression.
They offer expertise in efficient diagnosis processes, along with developing both comprehensive and individualized treatment plans tailored to each client’s unique needs and goals. Much like how a tailored fitness programs address individual health needs, therapy can be customized to address the specific challenges associated with atypical depression.
Ensuring each client receives genuine care and targeted support, mental health professionals work not only to alleviate symptoms of atypical depression but also foster long-term well-being by educating clients on tools and strategies to manage their symptoms more effectively and lead more fulfilling lives.
The first step to getting support is being able to access it. Grow Therapy makes it easy by connecting clients, therapists, and insurance companies to simplify mental healthcare.
Support groups and peer support
Connecting with other individuals facing similar circumstances as us can be incredibly validating – especially when dealing with atypical depression, as this can be an isolating experience for most.
Sharing experiences within support groups or through peer support services offers a valuable opportunity to connect with those who understand what you’re going through. This connection can provide much-needed support, empathy, and a sense of community, helping to alleviate feelings of isolation and offering practical insights into managing your condition.
