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Atypical Depression
Classification and external resources
ICD-10 F32.8

Atypical depression (AD) is a subtype of dysthymia and major depression, sharing many of the symptoms of both, but also being characterized by mood reactivity — being able to experience improved mood in response to positive events. In contrast, sufferers of "melancholic" depression generally cannot experience positive moods, even when good things happen. Additionally, atypical depression is characterized by reversed vegetative symptoms, namely over-eating and over-sleeping, and separately by interpersonal rejection sensitivity.

Despite its name, "atypical" depression is actually the most common subtype of depression[1][2] — up to 40% of the depressed population may be classified as having atypical depression.

Symptoms

The DSM-IV-TR defines Atypical Depression as a subtype of Major Depressive Disorder with Atypical Features, characterized by:

a) Mood reactivity (i.e., mood brightens in response to actual or potential positive events)

b) At least two of the following:

  • Significant weight gain or increase in appetite;
  • Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression);
  • Leaden paralysis (i.e., heavy, leaden feelings in arms or legs);
  • Long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment.

c) Criteria are not met for Melancholic Depression or Catatonic Depression during the same episode.

Research

In general, atypical depression tends to cause greater functional impairment than other forms of depression. Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression—usually beginning in teenage years. Similarly, patients with atypical depression are more likely to suffer from other psychiatric syndromes such as panic disorder, social phobia, avoidant personality disorder, or body dysmorphic disorder.[citation needed]

Medication response differs between chronic atypical depression and acute melancholic depression. While some studies[3] suggest that an older class of drugs, MAOIs, may be more effective at treating atypical depression, the modern SSRIs are usually quite effective, while the tricyclic antidepressants are not. In addition, SSRI response can often be enhanced with "booster" medications. And, medication treatment works best when combined with appropriate psychotherapy.[4] It is important to remember that such co-morbid syndromes as panic disorder may not be fully treated without additional medication.

It has been noted that patients with atypical depression often suffer from intense cravings for carbohydrates. A mineral supplement, chromium picolinate, was found to assuage these cravings.[5][6] It also was found to have an antidepressant effect on some atypical depression sufferers.[6]

Some hypothesize that atypical depression may be related to thyroid dysregulation. Some studies have found subtle thyroid abnormalities in people with atypical depression.[7] Another study suggests that patients may benefit from triiodothyronine, a medication used to treat hypothyroidism.[8]

References

  1. http://www.biopsychiatry.com/atypical.htm Course and treatment of atypical depression
  2. http://www.mcmanweb.com/article-200.htm Atypical Depression
  3. http://www.mayoclinic.com/health/atypical-depression/AN01363 Atypical depression: How is it different from 'regular' depression?
  4. http://www.workpsychcorp.com/newsweek2.html Depression Update: Atypical Depression
  5. Docherty JP, Sack DA, Roffman M, Finch M, Komorowski JR (September 2005). "A double-blind, placebo-controlled, exploratory trial of chromium picolinate in atypical depression: effect on carbohydrate craving". J Psychiatr Pract 11 (5): 302–14. PMID 16184071.
  6. 6.0 6.1 Davidson JR, Abraham K, Connor KM, McLeod MN (February 2003). "Effectiveness of chromium in atypical depression: a placebo-controlled trial". Biol. Psychiatry 53 (3): 261–4. PMID 12559660.
  7. http://web.archive.org/web/20070317050218/http://www.webmd.com/depression/news/20040315/atypical-depression-thyroid-link-still-alive Atypical Depression: Thyroid Link Still Alive
  8. Iosifescu DV, Nierenberg AA, Mischoulon D, et al. (August 2005). "An open study of triiodothyronine augmentation of selective serotonin reuptake inhibitors in treatment-resistant major depressive disorder". J Clin Psychiatry 66 (8): 1038–42. PMID 16086620. http://article.psychiatrist.com/?ContentType=START&ID=10001405.

Additional resources

  1. Atypical Depression Actually Very Typical
  2. Stewart JW, Quitkin FM, McGrath PJ, Klein DF (June 2005). "Defining the boundaries of atypical depression: evidence from the HPA axis supports course of illness distinctions". J Affect Disord 86 (2-3): 161–7. doi:10.1016/j.jad.2005.01.009. PMID 15935235. http://linkinghub.elsevier.com/retrieve/pii/S0165-0327(05)00015-7.

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