Atypical depression

Symptoms of depression can vary from person to person. Key signs and symptoms may include:

• Depression that temporarily lifts in response to good news or positive events
• Increased appetite that can cause weight gain
• Increased desire to sleep, usually more than 10 hours a day
• Heavy, leaden feeling in your arms or legs that lasts an hour or more in a day — a feeling that is different from fatigue
• Sensitivity to rejection or criticism, which affects your relationships, social life or job

Other symptoms also may be part of atypical depression, such as:

• Insomnia
• Disordered eating, such as bulimia, bingeing or extreme food restrictions
• Poor body image and fear of being fat
• Headaches and other aches and pains

Some researchers are beginning to think of atypical depression as part of a larger subgroup of reactive depressive disorders — depression caused as a reaction to external events or circumstances.

Atypical depression may occur as a feature of major depression or of mild, long-lasting depression (dysthymia). Symptoms of atypical depression may overlap with other subtypes of depression, such as melancholic or anxious distress depression.

For some people, signs and symptoms of atypical depression can be severe, such as feeling suicidal or not being able to do basic day-to-day activities.

When to see a doctor

If you feel depressed, make an appointment to see your doctor as soon as you can. Atypical depression may get worse if it isn’t treated. If you’re reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately.

Also consider these options if you’re having suicidal thoughts:

• Call your mental health specialist
• Call a suicide hotline number — in the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
• Seek help from your primary doctor or other health care provider
• Reach out to a close friend or loved one
• Contact a minister, spiritual leader or someone else in your faith community

If a loved one or friend is in danger of attempting suicide or has made an attempt:

• Make sure someone stays with that person
• Call 911 or your local emergency number immediately
• Or, if you can do so safely, take the person to the nearest hospital emergency room

It’s not known exactly what causes atypical depression or why some people have different features of depression. Atypical depression often starts in the teenage years, earlier than other types of depression, and can have a more long-term (chronic) course.

As with other types of depression, a combination of factors may be involved. These include:

• Brain differences. Neurotransmitters are naturally occurring brain chemicals that carry signals to other parts of your brain and body. When these chemicals are abnormal or impaired, the function of nerve receptors and nerve systems change, leading to depression.
• Inherited traits. Depression is more common in people whose blood relatives also have the condition.

Many factors seem to increase the risk of developing or triggering depression, whether it’s atypical or not. Risk factors may include:

• History of bipolar disorder
• Abuse of alcohol or recreational drugs
• Physical or sexual abuse
• Traumatic childhood experiences
• Certain personality traits, such as low self-esteem or being overly dependent
• Serious illness, such as cancer or heart disease
• Certain medications, such as some high blood pressure medications or sleeping pills (talk to your doctor before stopping any medication)
• Environmental stressors

Your risk of depression may also increase if you have:

• Blood relatives with a history of depression, bipolar disorder or alcoholism
• Stressful life events, such as the death of a loved one
• Depression after giving birth (postpartum depression)
• Family members who committed suicide
• Few friends or other personal relationships

Like other types of depression, atypical depression is a serious illness that can cause major problems. Atypical depression can result in emotional, behavioral and health problems that affect every area of your life.

For example, atypical depression can be associated with:

• Weight gain due to an increased appetite
• Personal and work relationship problems due to rejection sensitivity
• Drug or alcohol use due to trouble coping
• Other mental health disorders such as anxiety
• Suicide from feelings of depression

You may see your primary care doctor, or your doctor may refer you to a professional who specializes in mental health conditions. You may want to take a family member or friend along, if possible. Someone who comes with you may remember something that you missed or forgot.

What you can do

Before your appointment, make a list of:

• Any symptoms you’re experiencing, including any that may seem unrelated to the reason you scheduled the appointment
• Key personal information, including any major stresses or recent life changes
• All medications, vitamins and other supplements that you’re taking, and the doses
• Questions to ask your doctor

Basic questions to ask your doctor include:

• Is depression the most likely cause of my symptoms?
• What are other possible causes for my symptoms or condition?
• What kinds of tests will I need?
• What treatment is likely to work best for me?
• What are the alternatives to the approach that you’re suggesting?
• Are there any possible side effects or other issues with the medication you’re recommending? Is there a generic alternative?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a psychiatrist or other mental health provider?
• Do you have printed material that I can have? What websites do you recommend?

Don’t hesitate to ask any other questions.

What to expect from your doctor

Be ready to answer questions from your doctor to reserve time to discuss your concerns. Your doctor may ask:

• When did you or your loved ones first notice your symptoms of depression?
• How long have you felt depressed? Do you generally always feel down, or does your mood fluctuate?
• How severe are your symptoms? Do they interfere with your daily life or relationships?
• Does your mood ever swing from feeling down to feeling euphoric and full of energy?
• How do you react to good news or positive events?
• How do you react to criticism or rejection?
• Do you constantly feel hungry or regularly overeat?
• How much do you sleep every day?
• Do you often feel tired or irritable?
• Do you ever have suicidal thoughts?
• Do you have any blood relatives with depression or another mood disorder? What treatment has helped them?
• What other mental or physical health conditions do you have?
• Do you drink alcohol or use recreational drugs?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

These exams and tests can help your doctor rule out other problems that could be causing your symptoms, determine a diagnosis and check for any related complications:

• Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health to help determine what may be causing your depression. In some cases, depression may be linked to an underlying physical health problem.
• Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it’s functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to you about your symptoms, thoughts, feelings and behavior patterns. Your doctor may have you fill out a questionnaire to help answer these questions.
• DSM-5. Your mental health professional may compare your symptoms with the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Medications and talk therapy (psychotherapy) are effective for most people with depression, including atypical depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with atypical depression benefit from also seeing a psychologist or other mental health professional.

If you have severe depression, you may need a hospital stay or you may need to participate in an outpatient treatment program until your symptoms improve.

Here’s a closer look at your treatment options.

Medications

Discuss possible benefits, risks and side effects of medications with your doctor and pharmacist. Types of medications can include:

• Monoamine oxidase inhibitors (MAOIs). MAOIs are the oldest class of antidepressant medications, but they can have serious side effects. However, some experts feel that MAOIs, especially phenelzine (Nardil), can be effective for atypical depression. They also may help with anxiety, panic and other specific symptoms. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with certain foods and some medications, such as birth control pills, decongestants and certain herbal supplements. MAOIs can’t be combined with selective serotonin reuptake inhibitors (SSRIs).
• Other antidepressants. SSRIs, most notably sertraline (Zoloft) and fluoxetine (Prozac, Selfemra), can be an effective alternative to MAOIs. Tricyclic antidepressants are not as effective, but may be an option for treating atypical depression, particularly in people with a later onset of illness and a less chronic course. Other antidepressants may be beneficial, but have not been systematically studied for atypical depression.

You may need to try several medications or a combination of medications before you find one that works. This requires patience, as some medications need several weeks or longer to take full effect and for side effects to ease as your body adjusts.

Psychotherapy

Psychotherapy is a general term for treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as talk therapy.

Through these talk sessions, you can:

• Learn how to identify and change unhealthy behavior or thoughts
• Explore relationships and experiences
• Find better ways to cope and solve problems
• Set realistic goals for your life
• Regain a sense of satisfaction and control in your life
• Help ease depression symptoms such as hopelessness and anger

As part of your treatment, it’s important to also address other conditions that often accompany atypical depression, in particular anxiety and drug or alcohol use, as they can make your depression more difficult to treat.

Depression generally isn’t an illness that you can treat on your own. But in addition to professional treatment, these self-care steps can help:

• Stick to your treatment plan. Don’t skip psychotherapy sessions or appointments. Even if you’re feeling well, don’t skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
• Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan. Encourage your family members to learn about depression to help them understand and be supportive of you.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask relatives or friends to help watch for warning signs.
• Take care of yourself. Eat healthy, be physically active and get plenty of sleep. Consider walking, jogging, swimming, gardening or another activity that you enjoy. Sleeping well is important for both your physical and mental well-being. If you’re having trouble sleeping, talk to your doctor about what you can do.
• Avoid alcohol and recreational drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat. Talk with your doctor or therapist if you need help with this issue.

Make sure you understand the risks as well as possible benefits if you pursue alternative or complementary therapy. Don’t replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren’t a substitute for professional care.

Dietary supplements aren’t monitored by the Food and Drug Administration the same way medications are. You can’t always be certain of what you’re getting and whether it’s safe. Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk with your health care provider before taking any supplements.

Mind-body connections

Complementary and alternative medicine practitioners believe the mind and body must be in harmony for you to stay healthy. Examples of mind-body techniques that may be helpful for depression include acupuncture, relaxation techniques, exercise and spirituality.

Relying solely on these therapies is generally not enough to treat depression. However, they may be helpful when used in addition to medication and psychotherapy.

Talk with your doctor or therapist about improving your coping skills, and try these tips:

• Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
• Write in a journal. Journaling, as part of your treatment, may improve your mood by allowing you to express pain, anger, fear or other emotions.
• Read reputable self-help books and websites. Your doctor or therapist may be able to recommend helpful resources.
• Locate helpful groups. Many organizations, such as the National Alliance on Mental Illness (NAMI) and the Depression and Bipolar Support Alliance (DBSA), offer education, support groups, counseling and other resources. Employee assistance programs and religious groups also may offer help for mental health concerns.
• Don’t become isolated. Try to participate in social activities, and get together with family or friends regularly. Support groups for people with depression can help you connect to others facing similar challenges and share experiences.
• Learn ways to relax and manage your stress. Examples include meditation, progressive muscle relaxation, guided imagery, yoga and tai chi.
• Structure your time. Plan your day. You may find it helps to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
• Don’t make important decisions when you’re down. Avoid decision-making when you’re feeling depressed, since you may not be thinking clearly.

There’s no sure way to prevent depression. However, these strategies may help.

• Take steps to control stress, to increase your resilience and to boost your self-esteem.
• Reach out to family and friends, especially in times of crisis, to help you weather rough spells.
• Get treatment at the earliest sign of a problem to help prevent depression from worsening.
• Consider getting long-term maintenance treatment to help prevent a relapse of symptoms.