Atypical Depression

The "atypical" in atypical depression may be a bit of a misnomer. Atypical depression is anything but—nearly a third of patients diagnosed with depression suffer from it. As with other types of the disease, atypical depression occurs more frequently in women, those with anxiety and substance abuse problems, and among unmarried people.

Atypical symptoms include feeling worse in the evening than in the morning and the ability to cheer up in response to outside stimuli such as compliments or sympathy. Sufferers tend to not respond well to tricyclic antidepressants, but some MAOIs (monoamine oxidase inhibitors) and SSRIs (selective serotonin reuptake inhibitors) have proven effective as treatments. Many patients are also susceptible to certain phobias or panic attacks and it can sometimes be more severe than other kinds of depression. One of the main criteria that differentiates atypical depression from other forms is the patient's "oversensitivity to criticism and rejection" in conjunction with her other symptoms.

Signs & Symptoms of Atypical Depression

Aside from mood reactivity and rejection sensitivity, the symptoms of atypical depression may include:

  • sleep problems (especially oversleeping)
  • overeating and weight gain
  • fatigue (sometimes referred to as "leaden paralysis")


Atypical depression usually appears earlier in life than other forms of depression, lasts longer, and is frequently misdiagnosed. Because of the presence of fatigue, many of those with atypical depression are initially diagnosed with other conditions such as chronic fatigue syndrome, a personality disorder, or a neurosis. In addition, people with bipolar disorder may initially be misdiagnosed with atypical depression.

In a recent survey conducted by the National Depressive and Manic Depressive Association, it was ?found that 69 percent of patients with bipolar disorder were initially misdiagnosed. A third of those cases remained misdiagnosed for more than a decade, leading to prolonged suffering.  Because experts cannot agree on the definition of atypical depression, a diagnosis is not considered to be either "reliable or valid," which may make it difficult for sufferers to get the help they need.

Connections With Other Disorders

Some researchers believe that atypical depression may provide an insight into the connections between depression and certain personality disorders. Since atypical depression usually lasts longer ?than other forms of depression, it is often mistaken for a personality trait rather than a mood disorder.

For instance, having tendencies toward becoming easily frustrated, anticipating failure, and giving up easily is characteristic of an avoidant personality. In other cases, atypical depression may mimic borderline personality disorder in which a person is chronically angry or bored, suffers frequent mood shifts, is emotionally unstable, or has self-destructive impulses.

Histrionic personalities, on the other hand, are self-centered, shallow, and flamboyant, which may be characteristics of certain behaviors in people with atypical depression.

As mentioned, the biggest window may be atypical depression's relationship to bipolar disorder. Both share the characteristic of mood reactivity and often have similar symptoms, including oversleeping and overeating. Some researchers believe there is a relationship between atypical depression and personality disorders resulting from "defective mood regulation" in the brain.

In addition to avoidant, borderline, and histrionic personality disorders, other related conditions include obsessive-compulsive disorder, panic disorder, and bulimia. Evidence suggests these scientists may be on the right track toward effective treatment of atypical depression, as many of these disorders are currently treated with both mood stabilizers and antidepressants.