What Is Atypical Depression?

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Atypical depression is a type of depression that does not follow what was thought to be the “typical” presentation of the disorder. People with atypical depression experience mood reactivity. In other words, a person’s mood can temporarily improve if something positive happens.Atypical depression, which is now referred to as major depressive disorder with atypical features, is actually quite common. Unlike other forms of depression, people with atypical depression may respond better to a type of antidepressant known as amonoamine oxidase inhibitor (MAOI).At a GlanceUnlike those with typical depression, people with atypical depression respond to positive events with an improvement in mood, albeit temporarily. Symptoms include low mood, difficulty concentrating, fatigue, and short-lived improvements in mood when positive events occur.Like other forms of depression, genetics, family history, other conditions, and substance use can increase your risk of developing atypical depression. Effective treatments are available, which may include SSRIs, MAOIs, and psychotherapy.Symptoms of Atypical DepressionPeople with atypical depression signs and symptoms experience thecore symptoms of depression, such as:Low moodAppetite changesDifficulty sleepingAgitationFatigueDifficulty concentratingIn addition, they may experience the following symptoms:A mood that temporarily brightens after a positive event or happy newsIncreased appetite and weight gainA heavy feeling in the arms or legsBody achesSleeping for long periods at night or during the day (hypersomnia)Extreme sensitivity to rejection or perceived criticismLess common symptoms include:InsomniaHeadachesEating disordersPoor body imageWhat Causes Atypical Depression?The reasons some people experience atypical depression are not known. Brain chemistry, including problems with the functioning of neurotransmitters and neurotransmitter receptors, may play a role. However, research suggests that serotonin imbalances are not the primary cause of depression.Other factors that can raise your risk for atypical depression include:Family history.You are more likely to experience symptoms of atypical depression if others in your family also have depression or another type of mood disorder.Certain medical conditions.You may be more likely to experience atypical depression if you have a history ofbipolar disorders, anxiety disorders, avoidant personalities,body dysmorphic disorder, orsocial anxiety disorder.Substance use.Having a history of substance use can also increase the likelihood of depression.Stress and trauma. Experiencingstressfulortraumatic experiences, includingadverse events during childhood, can increase a person’s risk of developing atypical depression.Why Some People Are More Prone to DepressionHow Is Atypical Depression Diagnosed?Making a correct diagnosis is a critical step in getting treatment. Unfortunately, unlike many other health conditions, there isn’t a lab test, X-ray, or physical exam that can provide a definitive diagnosis.Your doctor must make a clinical diagnosis that takes into account your family history, risk factors, symptoms, and any underlying health concerns.Torule out any health conditionsthat may cause symptoms of depression or be an underlying cause, you may be givena blood test, drug screen, and imaging tests (such as a CT scan or MRI of the brain).You’ll likely undergo a depression test, either orally, on paper, or on a digital device before seeing the physician. Doctors typically compare your answers to the diagnostic criteria in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR)—but that’s only part of the diagnostic puzzle.MDD with atypical symptoms also has an early onset age and is typically diagnosed in the teenage years.All About the PHQ-9: Patient Healthcare Questionnaire for DepressionAtypical Depression Diagnostic CriteriaAccording to the DSM-5-TR, to be diagnosed with depressive disorder with atypical symptoms, a person must exhibit the ability to feel better temporarily in response to a positive life event (mood reactivity), plus any two of the following criteria for two or more weeks:Excessive eating or weight gainExcessive sleepFatigue, weakness, and feeling “weighed down"Intense sensitivity to rejectionStrongly reactive moodsIn the DSM-5-TR, atypical depression is known as major depressive disorder with atypical features.Treatment for Atypical DepressionTreatment for atypical depression often involves the use of medication, psychotherapy, and lifestyle changes.Medications for Atypical DepressionSelective serotonin reuptake inhibitors(SSRIs) and other relatively new medications are often the first-line choices for depression treatment because of their favorable side effect profiles. However, some research indicates that patients with atypical depression respond better tomonoamine oxidase inhibitors(MAOIs).Some common MAOIs include:Nardil (phenelzine)Parnate (tranylcypromine)Marplan (isocarboxazid)Emsam (selegiline)Still, SSRIs may be prescribed first simply because they do not have the potentiallyserious side effectsor dietary restrictions that MAOIs do. For example, to prevent dangerous blood pressure spikes, the person must avoidfoods and beverageshigh in tyramine while taking MAOIs.Wellbutrin (bupropion)is another medication used to treat atypical depression. It’s often prescribed along with other antidepressants to help counter the sexual side effects of those medications.Psychotherapy for Atypical DepressionPsychotherapy, or talk therapy, is also an important part of a treatment plan for atypical depression.Cognitive-behavioral therapy (CBT)has been scientifically proven effective in treating symptoms of depression.CBT can help you develop coping skills to better manage your stress, deal with negative thoughts and emotions, and manage your fears. These skills can be particularly helpful as you wait forantidepressant medication to begin working.Othertypes of psychotherapythat may be used for atypical depression include:Behavioral therapyCognitive therapyDialectical behavioral therapyIndividual, group, andfamily therapyInterpersonal therapyPsychodynamic therapyThe Best Online Therapy ProgramsWe’ve tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.Along with medication and psychotherapy, treatment for atypical depression may also include 30 to 45 minutes of light therapy (phototherapy) each morning, using alight boxwith a minimum power rating of 10,000 lux.Coping With Atypical DepressionIf atypical depression is interfering with your daily activities, working with your doctor to develop a treatment plan with medication and psychotherapy is a great first step. Beyond that, lifestyle modifications can help ease the symptoms and help you cope.Prioritize Nutrition and ExerciseDoing your best to stick witha healthful dietandregular exercise programwill improve your overall health and help decrease the symptoms of atypical depression. Aim to exercise five days a week for 30–60 minutes a day.Find Effective Relaxation TechniquesPractice mindfulness meditation and deep breathing. Deep-breathing exercises combined withmindfulness meditationcan teach you to be aware of your thoughts and feelings without reacting to them.Write in a JournalJournaling, or expressive writing, is a highly recommended tool for dealing with depression. Whether you do it daily or weekly, this habit can help you explore your feelings and counteract the effects of stress.Seek SupportDevelopingstrong social supportis important. This might include trusted family and friends or an online or in-person depression support group with whom you can connect and share your feelings and experiences.If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.TakeawaySee a mental health professional rather than your primary care physician for the best atypical depression treatment options. Not alltypes of depressionare alike, nor do they respond to the same medications. A physician in general practice is not likely to have the experience necessary to differentiate between depression subtypes or their most effective treatments.If you must see a primary care physician for your treatment—perhaps because of insurance or financial considerations—do the legwork to make up for the potential deficit in your physician’s knowledge. If you educate yourself and take an active role in your treatment, you’re less likely to slip through the diagnostic cracks.Tips for Living With Depression

Atypical depression is a type of depression that does not follow what was thought to be the “typical” presentation of the disorder. People with atypical depression experience mood reactivity. In other words, a person’s mood can temporarily improve if something positive happens.

Atypical depression, which is now referred to as major depressive disorder with atypical features, is actually quite common. Unlike other forms of depression, people with atypical depression may respond better to a type of antidepressant known as amonoamine oxidase inhibitor (MAOI).

At a GlanceUnlike those with typical depression, people with atypical depression respond to positive events with an improvement in mood, albeit temporarily. Symptoms include low mood, difficulty concentrating, fatigue, and short-lived improvements in mood when positive events occur.Like other forms of depression, genetics, family history, other conditions, and substance use can increase your risk of developing atypical depression. Effective treatments are available, which may include SSRIs, MAOIs, and psychotherapy.

At a Glance

Unlike those with typical depression, people with atypical depression respond to positive events with an improvement in mood, albeit temporarily. Symptoms include low mood, difficulty concentrating, fatigue, and short-lived improvements in mood when positive events occur.Like other forms of depression, genetics, family history, other conditions, and substance use can increase your risk of developing atypical depression. Effective treatments are available, which may include SSRIs, MAOIs, and psychotherapy.

Unlike those with typical depression, people with atypical depression respond to positive events with an improvement in mood, albeit temporarily. Symptoms include low mood, difficulty concentrating, fatigue, and short-lived improvements in mood when positive events occur.

Like other forms of depression, genetics, family history, other conditions, and substance use can increase your risk of developing atypical depression. Effective treatments are available, which may include SSRIs, MAOIs, and psychotherapy.

Symptoms of Atypical Depression

People with atypical depression signs and symptoms experience thecore symptoms of depression, such as:

In addition, they may experience the following symptoms:

Less common symptoms include:

What Causes Atypical Depression?

The reasons some people experience atypical depression are not known. Brain chemistry, including problems with the functioning of neurotransmitters and neurotransmitter receptors, may play a role. However, research suggests that serotonin imbalances are not the primary cause of depression.

Other factors that can raise your risk for atypical depression include:

Why Some People Are More Prone to Depression

How Is Atypical Depression Diagnosed?

Making a correct diagnosis is a critical step in getting treatment. Unfortunately, unlike many other health conditions, there isn’t a lab test, X-ray, or physical exam that can provide a definitive diagnosis.

Your doctor must make a clinical diagnosis that takes into account your family history, risk factors, symptoms, and any underlying health concerns.

Torule out any health conditionsthat may cause symptoms of depression or be an underlying cause, you may be givena blood test, drug screen, and imaging tests (such as a CT scan or MRI of the brain).

You’ll likely undergo a depression test, either orally, on paper, or on a digital device before seeing the physician. Doctors typically compare your answers to the diagnostic criteria in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR)—but that’s only part of the diagnostic puzzle.

MDD with atypical symptoms also has an early onset age and is typically diagnosed in the teenage years.

All About the PHQ-9: Patient Healthcare Questionnaire for Depression

Atypical Depression Diagnostic Criteria

According to the DSM-5-TR, to be diagnosed with depressive disorder with atypical symptoms, a person must exhibit the ability to feel better temporarily in response to a positive life event (mood reactivity), plus any two of the following criteria for two or more weeks:

In the DSM-5-TR, atypical depression is known as major depressive disorder with atypical features.

Treatment for Atypical Depression

Treatment for atypical depression often involves the use of medication, psychotherapy, and lifestyle changes.

Medications for Atypical Depression

Selective serotonin reuptake inhibitors(SSRIs) and other relatively new medications are often the first-line choices for depression treatment because of their favorable side effect profiles. However, some research indicates that patients with atypical depression respond better tomonoamine oxidase inhibitors(MAOIs).

Some common MAOIs include:

Still, SSRIs may be prescribed first simply because they do not have the potentiallyserious side effectsor dietary restrictions that MAOIs do. For example, to prevent dangerous blood pressure spikes, the person must avoidfoods and beverageshigh in tyramine while taking MAOIs.

Wellbutrin (bupropion)is another medication used to treat atypical depression. It’s often prescribed along with other antidepressants to help counter the sexual side effects of those medications.

Psychotherapy for Atypical Depression

Psychotherapy, or talk therapy, is also an important part of a treatment plan for atypical depression.Cognitive-behavioral therapy (CBT)has been scientifically proven effective in treating symptoms of depression.

CBT can help you develop coping skills to better manage your stress, deal with negative thoughts and emotions, and manage your fears. These skills can be particularly helpful as you wait forantidepressant medication to begin working.

Othertypes of psychotherapythat may be used for atypical depression include:

The Best Online Therapy ProgramsWe’ve tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain.

Along with medication and psychotherapy, treatment for atypical depression may also include 30 to 45 minutes of light therapy (phototherapy) each morning, using alight boxwith a minimum power rating of 10,000 lux.

Coping With Atypical Depression

If atypical depression is interfering with your daily activities, working with your doctor to develop a treatment plan with medication and psychotherapy is a great first step. Beyond that, lifestyle modifications can help ease the symptoms and help you cope.

Prioritize Nutrition and Exercise

Doing your best to stick witha healthful dietandregular exercise programwill improve your overall health and help decrease the symptoms of atypical depression. Aim to exercise five days a week for 30–60 minutes a day.

Find Effective Relaxation Techniques

Practice mindfulness meditation and deep breathing. Deep-breathing exercises combined withmindfulness meditationcan teach you to be aware of your thoughts and feelings without reacting to them.

Write in a Journal

Journaling, or expressive writing, is a highly recommended tool for dealing with depression. Whether you do it daily or weekly, this habit can help you explore your feelings and counteract the effects of stress.

Seek Support

Developingstrong social supportis important. This might include trusted family and friends or an online or in-person depression support group with whom you can connect and share your feelings and experiences.

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are struggling with depression, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat1-800-662-4357for information on support and treatment facilities in your area.

For more mental health resources, see ourNational Helpline Database.

Takeaway

See a mental health professional rather than your primary care physician for the best atypical depression treatment options. Not alltypes of depressionare alike, nor do they respond to the same medications. A physician in general practice is not likely to have the experience necessary to differentiate between depression subtypes or their most effective treatments.

If you must see a primary care physician for your treatment—perhaps because of insurance or financial considerations—do the legwork to make up for the potential deficit in your physician’s knowledge. If you educate yourself and take an active role in your treatment, you’re less likely to slip through the diagnostic cracks.

Tips for Living With Depression

5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA.The serotonin theory of depression: A systematic umbrella review of the evidence.Mol Psychiatry. 2022. doi:10.1038/s41380-022-01661-0Singh T, Williams K.Atypical depression.Psychiatry (Edgmont). 2006;3(4):33-39. PMID:21103169Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC.Treatment of atypical depression with cognitive therapy or phenelzine: A double-blind, placebo-controlled trial.Arch Gen Psychiatry. 1999;56(5):431-437. doi:10.1001/archpsyc.56.5.431Vukčević Marković M, Bjekić J, Priebe S.Effectiveness of expressive writing in the reduction of psychological distress during the COVID-19 pandemic: A randomized controlled trial.Front Psychol. 2020;11:587282. doi:10.3389/fpsyg.2020.587282Additional ReadingAmick HR, Gartlehner G, Gaynes BN, et al.Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis.BMJ. 2015;351:h6019. doi:10.1136/bmj.h6019McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF.A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression.Am J Psychiatry. 2000;157(3):344-50. doi:10.1176/appi.ajp.157.3.344Nelson E, McElroy S.Atypical depression puzzled? How to piece together symptoms and treatments. Current Psychiatry. 2003 April;2(4):12-19.Singh, T. and Williams, K.Atypical depression.Psychiatry.2006 Apr;3(4):33-9.

5 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA.The serotonin theory of depression: A systematic umbrella review of the evidence.Mol Psychiatry. 2022. doi:10.1038/s41380-022-01661-0Singh T, Williams K.Atypical depression.Psychiatry (Edgmont). 2006;3(4):33-39. PMID:21103169Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC.Treatment of atypical depression with cognitive therapy or phenelzine: A double-blind, placebo-controlled trial.Arch Gen Psychiatry. 1999;56(5):431-437. doi:10.1001/archpsyc.56.5.431Vukčević Marković M, Bjekić J, Priebe S.Effectiveness of expressive writing in the reduction of psychological distress during the COVID-19 pandemic: A randomized controlled trial.Front Psychol. 2020;11:587282. doi:10.3389/fpsyg.2020.587282Additional ReadingAmick HR, Gartlehner G, Gaynes BN, et al.Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis.BMJ. 2015;351:h6019. doi:10.1136/bmj.h6019McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF.A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression.Am J Psychiatry. 2000;157(3):344-50. doi:10.1176/appi.ajp.157.3.344Nelson E, McElroy S.Atypical depression puzzled? How to piece together symptoms and treatments. Current Psychiatry. 2003 April;2(4):12-19.Singh, T. and Williams, K.Atypical depression.Psychiatry.2006 Apr;3(4):33-9.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA.The serotonin theory of depression: A systematic umbrella review of the evidence.Mol Psychiatry. 2022. doi:10.1038/s41380-022-01661-0Singh T, Williams K.Atypical depression.Psychiatry (Edgmont). 2006;3(4):33-39. PMID:21103169Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC.Treatment of atypical depression with cognitive therapy or phenelzine: A double-blind, placebo-controlled trial.Arch Gen Psychiatry. 1999;56(5):431-437. doi:10.1001/archpsyc.56.5.431Vukčević Marković M, Bjekić J, Priebe S.Effectiveness of expressive writing in the reduction of psychological distress during the COVID-19 pandemic: A randomized controlled trial.Front Psychol. 2020;11:587282. doi:10.3389/fpsyg.2020.587282

American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.

Moncrieff J, Cooper RE, Stockmann T, Amendola S, Hengartner MP, Horowitz MA.The serotonin theory of depression: A systematic umbrella review of the evidence.Mol Psychiatry. 2022. doi:10.1038/s41380-022-01661-0

Singh T, Williams K.Atypical depression.Psychiatry (Edgmont). 2006;3(4):33-39. PMID:21103169

Jarrett RB, Schaffer M, McIntire D, Witt-Browder A, Kraft D, Risser RC.Treatment of atypical depression with cognitive therapy or phenelzine: A double-blind, placebo-controlled trial.Arch Gen Psychiatry. 1999;56(5):431-437. doi:10.1001/archpsyc.56.5.431

Vukčević Marković M, Bjekić J, Priebe S.Effectiveness of expressive writing in the reduction of psychological distress during the COVID-19 pandemic: A randomized controlled trial.Front Psychol. 2020;11:587282. doi:10.3389/fpsyg.2020.587282

Amick HR, Gartlehner G, Gaynes BN, et al.Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis.BMJ. 2015;351:h6019. doi:10.1136/bmj.h6019McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF.A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression.Am J Psychiatry. 2000;157(3):344-50. doi:10.1176/appi.ajp.157.3.344Nelson E, McElroy S.Atypical depression puzzled? How to piece together symptoms and treatments. Current Psychiatry. 2003 April;2(4):12-19.Singh, T. and Williams, K.Atypical depression.Psychiatry.2006 Apr;3(4):33-9.

Amick HR, Gartlehner G, Gaynes BN, et al.Comparative benefits and harms of second generation antidepressants and cognitive behavioral therapies in initial treatment of major depressive disorder: systematic review and meta-analysis.BMJ. 2015;351:h6019. doi:10.1136/bmj.h6019

McGrath PJ, Stewart JW, Janal MN, Petkova E, Quitkin FM, Klein DF.A placebo-controlled study of fluoxetine versus imipramine in the acute treatment of atypical depression.Am J Psychiatry. 2000;157(3):344-50. doi:10.1176/appi.ajp.157.3.344

Nelson E, McElroy S.Atypical depression puzzled? How to piece together symptoms and treatments. Current Psychiatry. 2003 April;2(4):12-19.

Singh, T. and Williams, K.Atypical depression.Psychiatry.2006 Apr;3(4):33-9.

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