Atypical Depression: When Depression Sometimes "Turns Off"

Katy Kandaris-Weiner, LPC
7/26/2023

Our moods naturally rise and fall in response to stimuli. Habits such as watching movies, listening to music, seeing friends, and playing with our pets are all activities that can pull us out of a funk. Often, people diagnosed with depressive disorders lose interest in activities like these that they once enjoyed, and their mood doesn’t improve during a depressive episode. 

This is not always the case, however. Certain stimuli can actually improve a person’s mood, feelings, and experience—even during a depressive episode—for a person dealing with atypical depression.

What Is Atypical Depression?

Atypical depression is a form of Major Depressive Disorder (MDD). What sets it apart is the fact that, unlike typical MDD, positive situations and experiences can elevate a person’s mood. MDD involves depressive episodes that ebb and flow. These episodes end eventually, but, in the meantime, no specific event, circumstance, or stimuli can necessarily make a person “pull out of” the episode.

Many who have atypical depression may not know it because they seem to suddenly “snap” out of their depression when something good happens to them. This is often diagnosed as “MDD with atypical features.” 

Atypical depression is a fairly common form of MDD. Researchers estimate 18-36% of those with a depressive disorder have atypical depression. Women are four times more likely to have it than men. 

What Are Atypical Depression Symptoms?

Atypical depression presents itself in nearly identical ways to other types of depression, including sadness, emptiness, and fatigue. Other symptoms of atypical depression include:

  • Drastic changes in appetite
  • Difficulty sleeping
  • Rejection sensitivity
  • Difficulty concentrating
  • Anxiety

Those with atypical depression may also have bouts of hypersomnia, where they end up sleeping 10 or more hours at a time. In this way, atypical depression symptoms can mirror the indicators of “regular” depression.

How Is Atypical Depression Different From Other Depressive Disorders?

With such similar symptoms, it can be difficult to differentiate between atypical and other types of depression. However, there are a few tell tale signs that are unique to atypical depression:

Reactivity

External positive stimuli don’t do much to improve the moods of those with typical MDD. The severity of their depression may lessen in natural cycles, but it takes consistent treatment to cause major changes.

Those with atypical depression, however, are far more reactive. Their elevated mood may be temporary, but it is noticeable. Those with atypical depression do show heightened rejection sensitivity, but research has yet to prove whether it necessarily “triggers'' a depressive episode. The effects of positive experiences in brightening someone’s mood, however, are well-documented.

Physical Symptoms

Atypical depression also has unique physical symptoms. While body aches are commonly reported as a symptom of depression, people with the atypical subtype appear more prone to it. One study found that people with atypical depression have higher counts of a specific protein involved in inflammation.

People with atypical depression also report heavy arms and legs caused by extreme fatigue that those with typical MDD don’t seem to have. This is called “leaden paralysis,” where people feel like their limbs are so heavy, they have trouble moving.

Atypical Depression And Bipolar Disorder

The fact that a person’s mood can shift from depressed to “normal” quickly might sound like an indicator of bipolar disorder. Research is still being done to determine the relationship between atypical depression and bipolar disorder. 

Bipolar disorder episodes, or “lows,” seem to mimic symptoms unique to atypical depression, including trouble sleeping and rejection sensitivity.

Causes And Risk Factors Of Atypical Depression

As with many mental health disorders, the exact causes of atypical depression are unknown. Researchers know a great deal about what is happening in the brain, but not exactly why. The line between risk factors and causes can be a bit blurry.

Genetics

Family history of depression or other mental health disorders is usually the driving risk factor in whether a person develops depression. Atypical depression is no different. The Mayo Clinic suggests that family or personal history of bipolar disorder also increases the risk of developing atypical depression.

Brain Chemistry

You’ve probably heard that depression is caused by a chemical imbalance in your brain. What this really means is that the brain isn’t releasing some of the ‘feel good’ hormones such as serotonin and dopamine. Some people just naturally have abnormal receptors for these hormones.

Trauma

Trauma can affect a person for a long time. Again, while not a direct cause of atypical depression, trauma can lead to it due to stress hormones being present in the body for long after the traumatic experience is over. 

Substance Abuse And Other Comorbidities

Substance use and abuse makes a person more likely to be diagnosed with depression. Substance use disorders are medical conditions, and can have lasting effects on brain chemistry.

It’s common for someone to have more than one co-occurring disorder. We mentioned bipolar disorder already, but anxiety, serious physical illnesses, and even other types of depression (like seasonal affective disorder) can put a person at risk for developing atypical depression.

Treating And Managing Atypical Depression

The good news is that atypical depression commonly responds well to the same treatments for MDD. Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, and other talk therapies are generally effective in helping a person still live a full and healthy life with atypical depression. 

As far as prescription treatment, atypical depression seems to respond better to rarer types of anti-depression medication called monoamine oxidase inhibitors (MAOIs). Talk to your doctor as they can advise you on helpful prescription options, and will be able to monitor and adjust your treatment, if needed.

Additionally, doctors recommend participating in self-care oriented activities that can lessen the severity of some depression symptoms and help you cope. Stress control activities like relaxation, journaling, and meditation are more effective than most people assume. Exercise is another helpful tool as it is known to increase dopamine levels, which can curb the effects of atypical depression. 

Start Your Journey to Wellness Today

It might seem strange to have depression that comes and goes, but that doesn’t make what you’re experiencing any less legitimate. Atypical depression isn’t talked about much, but it’s still a very real struggle for a lot of people.

By scheduling a consultation at Inner Balance Counseling, you’ll be partnered with a licensed therapist to work with you at your pace on your healing journey. Contact us today. 

Reach out. Show up. Feel Better.

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Katy Kandaris-Weiner, LPC
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