Atypical depression, once classified as an actual type of depression, is no longer recognized as a separate condition. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it’s known as major depression with atypical features. 

Atypical depression differs from major depressive disorder (MDD) in one major regard. The mood of someone with atypical depression can often be affected in a good way by positive life events. Such positive experiences generally have little or no effect on a person with true, classic major depressive disorder. Atypical depression got its name because it was identified subsequent to identifying melancholic depression, which, in simplest terms, is the opposite of atypical depression. Those with melancholic depression typically do not feel better after experiencing something that should bring them happiness.

Despite its name, ‘atypical’ depression is not atypical at all. According to research, approximately 40% of people with depression have atypical depression. Most research suggests that atypical depression is about four times more common in women than men. 

The good news for those diagnosed with atypical depression is that this mental health condition responds very well to treatment. Treatment for atypical depression generally includes a combination of therapy and medication; however, it’s important to note that treatment plans are customized to the person based on the severity and frequency of symptoms. 

Keep reading to learn more about atypical depression. 

Defining Atypical Depression

Atypical depression, also referred to as major depressive disorder with atypical features, is one of four types of depression. Unlike the others, though, people with atypical depression can see their moods lift in response to positive events and good news. As previously mentioned, positive events have little to no effect on most people living with just MDD. Those with atypical depression might feel sad, but their mood can lift when something good happens to them.

Major depressive disorder with atypical features

Major depressive disorder with atypical features is classified as a subtype of MDD in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V). 

While in some ways similar to MDD, atypical depression has a much greater rate of mood sensitivity. That means people with atypical depression are more likely to be uplifted by positive events, good news, and improving circumstances. Yes, they’ll still face dark thoughts and other symptoms of depression, but the hallmark symptom is that sadness and hopelessness can decrease when good things happen — a visit from a loved one, an unexpected present, a financial windfall, praise at work, or the development of a positive personal relationship. 

Atypical depression starts early in life and is more likely to occur in people with a mood disorder like bipolar disorder or seasonal affective disorder. It is a crucial indicator that can be used to predict the clinical course of depression, which has implications for treatment decisions.

Atypical vs typical depression (non-atypical depression)

While these two mental health conditions are very similar and share many symptoms, there are a few marked differences. The key difference we’ve already noted — atypical depression means there’s the potential for a mood shift when good things happen in life. 

There are other differences as well, though. Atypical depression symptoms, compared to those of MDD, include excessive sleepiness. With MDD, a person may be either excessively sleepy or have insomnia. The same dichotomy exists with eating habits. Someone with atypical depression often eats too much and gains weight. A person with MDD may either eat too much or too little.

“Given that atypical depression varies in symptoms from typical depression, it’s important to discuss all that you are experiencing with your doctor or licensed mental health professional so that you can get support for all of your symptoms.”

Talkspace therapist Jill E. Daino, LCSW-R

Symptoms of Atypical Depression

Many symptoms of atypical depression are similar to major depression symptoms. Atypical symptoms can include:

  • Excessive sleepiness
  • Eating too much resulting in significant weight gain
  • Low energy
  • Inability to focus and concentrate  
  • Negative thoughts and/or thoughts of suicide
  • Reaction sensitivity — which is a major difference between the two conditions — positive mood can result from good news and/or positive events

Diagnosing Atypical Depression

Atypical depression is diagnosed using the criteria set out in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Indicators include mood reactivity (mood improves with positive events and circumstances) as well as 2 or more of the following atypical depression symptoms:

  • Extreme weight gain or a significant increase in appetite (also known as hyperphagia) 
  • Sleeping more than normal or too much (known as hypersomnia) — note this contrasts with the potential for insomnia that may be present in depression
  • An extreme, heavy sense that can make moving the legs or arms extremely difficult (known as leaden paralysis)
  • A pattern of interpersonal rejection sensitivity that isn’t limited to episodes of mood disturbance, resulting in social or professional strain and impairment

A psychiatrist, doctor, therapist, or psychologist can make this type of depression diagnosis after meeting with someone, reviewing their medical history, and ruling out any possible medical or physical condition that might be causing the symptoms.

What Causes Atypical Depression?

Like the causes of depression, the exact causes of atypical depression are unknown. However, some factors appear to play a role in whether a person develops this disorder or not. 

  • Genetics seem to contribute to a person developing atypical depression. People with a close family member with chronic atypical depression, usually as a part of bipolar disorder, are much more likely to develop it themselves. It’s also worth noting that a hormonal imbalance can cause hormonal depression, of which you might also experience atypical symptoms.
  • In addition, trauma and stress over time contribute to a person’s risk of developing atypical depression. Trauma in childhood, physical or emotional abuse, a history of substance abuse, overwhelming grief, or significant illness or health conditions are all considered to play a role.
  • Neurotransmitter impairment or brain chemical imbalance that affects how brain signals are transmitted to various body parts might play a role. 
  • Drug and alcohol use or abuse is thought to be a factor that may contribute to someone eventually developing atypical depression. 

“While the exact cause of atypical depression is not known, it’s important to remember what you are experiencing, while overwhelming at times, can be treated using medication, talk therapy, and lifestyle adjustments, which all contribute to managing atypical depression.”

Talkspace therapist Jill E. Daino, LCSW-R

Treatment for Atypical Depression

The good news is that atypical depression usually responds very well to treatment. Learning how to treat depression with atypical features generally includes a combination of psychotherapy and medication. It’s important to point out, however, that each person’s treatment plan will be unique and customized to their specific symptoms and situation. 

Therapy

Psychotherapy is a key component of atypical depression treatment. This type of therapy for depression, also referred to as “talk therapy,” focuses on teaching someone how to manage and redirect negative thoughts and improve their communication and interpersonal relationships. Psychotherapy is also useful in helping to identify the root cause of trauma that may be contributing to atypical depression.

Medication

Depression medication is often used in conjunction with psychotherapy to treat all types of depression. Commonly prescribed medications for this disorder include monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs). Another class of antidepressants, tricyclic antidepressants, hasn’t been found to work well for people with atypical depression.

Ask your primary care physician for a referral to find a mental health professional with experience treating atypical depression. If you don’t have one, or if you’d rather connect with a psychiatrist or therapist online, you can always find a mental health professional through Talkspace.Our online therapy platform makes therapy for atypical depression simple and convenient. 

You don’t even have to leave the comfort of your own home when you use Talkspace. Our therapists are trained and skilled at treating all types of depression and other mental health conditions, so you can trust you’ll be in good hands. You don’t have to suffer from atypical depression. Help is available if you want it. Reach out to Talkspace today to get started.