Depression Diagnosis What Is Atypical Depression? By Nancy Schimelpfening Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. Learn about our editorial process Updated on May 27, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Verywell / Alison Czinkota Table of Contents View All Table of Contents Atypical Depression Symptoms Causes Diagnosing Atypical Depression Atypical Depression Treatment Coping Atypical depression is a type of depression that does not follow what was thought to be the "typical" presentation of the disorder. In general, people with atypical depression experience similar symptoms as those with major depressive disorder (MDD) but with one crucial difference: mood reactivity. In other words, a person's mood is able to 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 a monoamine oxidase inhibitor (MAOI). MDD with atypical symptoms also has an early onset age and is typically diagnosed in the teenage years. Unlike those with typical depression, those with atypical depression respond to positive events with an improvement in mood, albeit temporarily. Atypical Depression Symptoms People with atypical depression signs and symptoms experience the core symptoms of depression, such as: Low moodAppetite changesDifficulty sleepingAgitationFatigueDifficulty concentrating In 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 criticism Less common symptoms include: InsomniaHeadachesEating disordersPoor body image Causes The reasons some people experience atypical depression is not known. A potential cause is an imbalance in certain neurotransmitters, including dopamine, serotonin, and norepinephrine, which all influence mood. 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 of bipolar disorders, anxiety disorders, avoidant personalities, body dysmorphic disorder, or social phobia.Substance use. Having a history of substance use can also increase the likelihood of depression. Why Some People Are More Prone to Depression Diagnosing Atypical Depression 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. Instead, your doctor must make a clinical diagnosis that takes into account your family history, risk factors, symptoms, and any underlying health concerns. To rule out any health conditions that may cause symptoms of depression or be an underlying cause, you may be given a 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)—but that's only part of the diagnostic puzzle. Screening for Depression: How Depression Tests Work According to the DSM-5, 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 moods Atypical Depression Treatment 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 to monoamine 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 potentially serious side effects or dietary restrictions that MAOIs do. For example, to prevent dangerous blood pressure spikes, the person must avoid foods and beverages high in tyramine while taking MAOIs. How MAOIs Work and Common Side Effects Wellbutrin (bupropion) is another medication used to treat atypical depression. It's often prescribed along with other antidepressants to help counter sexual side effects of those medications. 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 for antidepressant medication to begin working. Other types of psychotherapy that may be used for atypical depression include: Behavioral therapyCognitive therapyDialectical behavioral therapyIndividual, group, and family therapyInterpersonal therapyPsychodynamic therapy The Best Online Therapy Programs We'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 a light box with a minimum power rating of 10,000 lux. Coping 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 with a healthful diet and regular exercise program will 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. Practice mindfulness meditation and deep breathing. Deep-breathing exercises combined with mindfulness meditation can 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. Developing strong social support is 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 the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. A Word From Verywell See a mental health professional rather than your primary care physician for the best atypical depression treatment options. Not all types of depression are 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 4 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.; 2022. Major Depressive Disorder: Cognitive and Neurobiological Mechanisms. InTech. 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 Additional Reading 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. By Nancy Schimelpfening Nancy Schimelpfening, MS is the administrator for the non-profit depression support group Depression Sanctuary. Nancy has a lifetime of experience with depression, experiencing firsthand how devastating this illness can be. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Depression Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.