Atypical Depression: Symptoms, Diagnosis and Treatment

The atypical depression is a mood disorder that is characterized by specific symptoms and manifestations.

This psychopathological alteration is classified as a type of depression, since the clinical presentation is mainly depressive. In fact, atypical depression meets the diagnostic criteria for the establishment of major depressive disorder.

However, the particular nomenclature of atypical depression responds to the fact that this disorder is characterized by presenting a series of symptoms that are “atypical” and not very prevalent in most cases of depression.

Atypical Depression Symptoms

In this sense, apart from the typical depressive symptoms such as sadness or the inability to experience gratification, atypical depression is usually characterized by features such as: reactive mood, tiredness in arms and legs, increased appetite, hypersomnia and hypersensitivity to personal rejection.


Likewise, atypical depression stands out for requiring different interventions from other types of depression. In general, people with this type of condition do not respond well to treatment with tricyclic antidepressants and they do respond to MAOIs.

In this article we review the main characteristics of this type of depression, as well as its symptoms, its causes, diagnosis and treatment.

Characteristics of atypical depression

Atypical depression is considered, nowadays, as a low prevalent type of depressive disorder that is characterized by presenting a clinical and symptomatology qualitatively different to most cases of depression.

The establishment of this variant of depression originated in the 50s of the last century, when a group of English psychiatrists described a series of subjects with depressive symptoms that presented “atypical” manifestations.

The main symptoms that were described at the beginning of this pathology were the heaviness and tiredness of both the upper extremities and the lower extremities.

Due to this reference, in the 70s a group of researchers from Columbia University used the term “heavy paralysis” to refer to depressed patients who had intense symptoms of fatigue in the arms and legs.

The appearance of a different nomenclature to refer to a specific type of depression generated scientific controversy about this type of alteration.

Subsequently, it was established that people with this type of symptoms suffer from a depressive disorder that is accompanied by a series of manifestations different from those experienced in the rest of cases of depression.

Thus, atypical depression today is a particular type of depression, in the same way as other types such as minor depression, major depression, dysthymia , postpartum depression or premenstrual dysphoric disorder.

Finally, it must be borne in mind that the “atypical” nomenclature refers to the presence of uncommon symptoms in other cases of depression, but does not refer to its prevalence.

That is, multiple studies have shown that atypical depression is not one of the less prevalent mood changes, so many people can have this type of disorder.


The general symptoms of atypical depression are the same as those of the rest of depressions. That is, the person presents a depressed mood most of the day, as well as a significant decrease in interest or pleasure for all or almost all activities.

In fact, these two main symptoms are essential for the diagnosis of any type of depressive disorder. As atypical depression constitutes a type of depression, its two nuclear manifestations are the experimentation of sadness and the diminution of interest and / or gratification.

However, apart from these two nuclear manifestations, atypical depression is notable for the incorporation of low-prevalence or little-important manifestations in the rest of the depressive typologies.

In this sense, this alteration of mood is notable for presenting the following symptoms cataloged as “atypical”

Vegetative signs

The vegetative manifestations that can be more or less prevalent in cases of depression, are one of the predominant symptoms of atypical depression.

Among this type of signs, asthenia and fatigability stand out in the context of a global lack of vitality. These manifestations are more marked during the first hours of the day in many patients.

Likewise, headaches of atypical characteristics, digestive disorders, loss of appetite, dry mouth, dyspepsia, gastralgia, constipation, diarrhea, loss of libido, impotence or balance disorder are usually present in this disorder .

Finally, in some cases of atypical depression the person may present a disorder that resembles vertigo, which is characterized by the feeling of insecurity in the march, without falling.

Anxiety and phobias

The anxious alterations are another of the predominant symptoms in cases of atypical depression. People with this condition usually have high anxiety during most of the day.

In this sense, it is usual for anxiety to appear continuously to the decrease in mood. The person may be anxious about the fact of being depressed and the main discomfort lies in their altered mood.

Night deterioration

Another typical sign of atypical depressions lies in a worsening of the state and symptoms at night.

People with this type of mood disturbance can “feel better” during the day and experience an accentuation of their depressive symptomatology during the night.

Initial insomnia

The difficulties to fall asleep are also important and recurrent manifestations of this psychopathology.

People with this type of disorder tend to have a lot of trouble sleeping, and they can spend sleepless nights because of their difficulties closing their eyes.

Daytime hypersomnia

As a consequence and as a cause of the previous manifestation, it is usual for subjects with this type of depression to have high hours of sleep during the day.

The fact of experiencing an accentuation of the depressive symptomatology during the night and the difficulties to fall asleep usually result in extreme tiredness and drowsiness during the day.

Likewise, the high hours rested during the day usually increase even more the difficulties to fall asleep at night. People with atypical depression usually sleep during the day and be awake and anxious at night.


Unlike most cases of depressive disorders, where symptoms are usually accompanied by decreased appetite and weight loss, hyperphagia is usually observed in atypical depression.

The subjects with this psychopathological alteration usually experience an excessive increase of the appetite sensation, fact that can lead to the realization of uncontrolled intakes and a remarkable increase of weight.


Atypical depression also stands out for preserving a certain reactivity of the state of mind. That is, people with this type of condition are able to experience a slight increase in mood in the face of positive events.

This factor is important when it comes to differentiating it from other depressive modalities, where interest and pleasure experimentation are highly diminished.

However, and at the same time, atypical depression usually presents a high reactivity towards negative events. People with this alteration tend to collapse in the face of minor adversities, falling into a paralyzing position.

Heavy abatement or paralysis

Finally, the atypical depression stands out for the experimentation of a feeling of heaviness in the arms and legs.

This factor was one of the most important when initiating research about this type of depression, since subjects with other depressive modalities do not usually experience specific symptoms in the extremities.

However, this is not the main symptom of atypical depression since other mood alterations can also be accompanied by elevated feelings of fatigue and physical exhaustion.


For the diagnosis of atypical depression it is necessary to establish the diagnosis of major depressive disorder, as well as to meet the criteria that establish the presence of atypical symptoms.

In this sense, the criteria that must be met to establish the presence of this alteration are:

Diagnosis of major depressive disorder

1. Presence of two or more major depressive episodes characterized by:

1.1 Presence of five (or more) of the following symptoms during a two-week period that represent a change from the previous activity:

  • Depressive mood most of the day.
  • Sharp decrease in interest or capacity for pleasure in all or almost all activities.
  • Major weight loss without regimen or weight gain.
  • Insomnia or hypersomnia almost every day.
  • Agitation or slowing psych0m0tor almost every day.
  • Fatigue or loss of energy almost every day.
  • Feelings of excessive or inappropriate guilt or inadequacy.
  • Decreased ability to think or concentrate.
  • Recurrent thoughts of death.

1.2 The symptoms do not meet the criteria for a mixed episode.

1.3 Symptoms cause clinically significant discomfort or impairment in social, occupational or other important areas of the individual’s activity.

1.4 The symptoms are not due to the direct physiological effects of a substance or a medical illness.

1.5 The symptoms are not better explained by the presence of a grief.

  1. Major depressive episodes are not better explained by the presence of a schizoaffective disorder and are not superimposed on a schizophrenia, a schizophreniform disorder, a delusional disorder or an unspecified psychotic disorder.
  1. There has never been an episode.

Diagnosis of atypical symptoms

Depressive disorder is characterized by the following symptomatology:

  1. Loss of pleasure in all or almost all activities.
  2. Lack of reactivity to usually pleasurable stimuli.
  3. Three or more of the following symptoms.
  4. A distinctive quality of depressed mood.
  5. Depression is usually worse in the morning.
  6. Early awakening at least two hours before the usual time to open your eyes.
  7. Psych0m0tor slowing or agitation.
  8. Significant anorexia or weight loss.
  9. Excessive or inappropriate guilt.


Atypical depression is usually related to different situations or problematic elements that may arise from the disorder itself. In this sense, special care must be taken in the following aspects:

Weight increase

The alteration of the appetite that causes the atypical depression is correctly documented and demonstrated, reason why this alteration constitutes a high risk factor for the obesity.

Trying to balance intake and diet is a secondary therapeutic goal but it can be highly important in different cases.

Anxiety disorders

Although anxious symptomatology is not the main manifestation of atypical depression, it may be important within the clinical picture.

People with this type of depression may have higher risks of developing an anxiety disorder such as social phobia or panic attacks.


As with the great majority of mood alterations, suicide is the main risk factor of the pathology.

The evaluation of both death ideas and self-critical thoughts and suicidal planning should be paramount in the treatment of atypical depression.


Currently, there are specific treatments to intervene atypical depression. In general, people who suffer from this disorder have serious clinical conditions that require medication.

Likewise, psychotherapy is a highly recommended tool to accompany pharmacological treatment.


Unlike most types of depression, people with atypical depression do not usually respond adequately to treatment with tricyclic antidepressants.

In this sense, the drugs of first choice to treat this psychopathology are inhibitors of monoamine oxidase (MAOI). However, these medications should be used with caution because they can cause important side effects.

Also Read: Citalopram: Properties, Side Effects and Indications

Another type of psychotropic drugs used in the treatment of atypical depression are the selective inhibitors of serotonin reuptake (SSRI). These drugs have fewer side effects than MAOIs and are effective drugs for atypical depression.