As with any type of depression, atypical depression can make you feel blue and keep you from enjoying life. When you have atypical depression, a particular pattern of signs and symptoms tends to occur. You may feel hungry and gain weight. You may sleep a lot, and your arms and legs may feel heavy. Many people who have atypical depression have a hard time maintaining relationships and are especially afraid of rejection by others.

Atypical depression often starts in the teenage years and is more common in women than in men. Despite the name, atypical depression is not uncommon or unusual. As with other forms of depression, treatment for atypical depression includes medications, psychological counseling (psychotherapy) and lifestyle changes.

Symptoms

1)Feelings of sadness, emptiness or feeling tearful
2)Loss of interest or pleasure in normal activities

In addition to standard symptoms of depression, atypical depression symptoms also include:

3)Increased appetite
4)Unintentional weight gain
5)Increased desire to sleep
6)Heavy, leaden feeling in the arms and legs
7)Sensitivity to rejection or criticism that interferes with your social life or job
8)Relationship conflicts
9)Trouble maintaining long-lasting relationships
10)Fear of rejection that leads to avoiding relationships

Having depression that temporarily lifts with good news or positive events but if you have suicidal thoughts; or if you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

1)Contact a family member or friend.
2)Seek help from your doctor, a mental health provider or another health care professional.
3)Call a suicide hot line number -- in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
4)Contact a minister, a spiritual leader or someone in your faith community.

When to get emergency help

If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Causes

It is not known exactly what causes atypical depression. As with other types of depression, a combination of factors may be involved. These include:

1)Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that are thought to play a direct role in depression. When these chemicals are out of balance, it may lead to depression symptoms.
2)Inherited traits. Depression is more common in people whose biological family members also have the condition.
3)Life events. Events such as the death or loss of a loved one, financial problems and high stress can trigger depression in some people.
4)Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.

Western Medicine Treatment

Treatment for atypical depression is generally the same as treatment for other types of depression. Medications and psychological counseling (psychotherapy) are effective for most people.

In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Most people with atypical depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy.

Atypical depression most often occurs along with mild, long-lasting depression. However, it can cause more severe symptoms in some people, such as feeling suicidal or not being able to do basic day-to-day activities. If you have severe depression, a doctor, loved one or guardian may need to guide your care until you are well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Medications

A number of medications are available to treat depression. They include:

1)Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.

2)Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. People with liver disease should not take duloxetine.

3)Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It is one of the few antidepressants that do not cause sexual side effects. At high doses, bupropion may increase your risk of having seizures.

4)Atypical antidepressants. These medications are called atypical because they do not fit neatly into another antidepressant category. They include trazodone (Desyrel) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep.

4)Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more severe side effects, a tricyclic antidepressant generally is not prescribed unless you have tried an SSRI first without an improvement in your depression. Tricyclic antidepressants include amitriptyline, doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor) and others. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Older adults taking these medications are susceptible to memory problems, confusion and hallucinations. Tricyclic antidepressants are also known to cause weight gain.

5)Monoamine oxidase inhibitors (MAOIs). MAOIs -- such as isocarboxazid (Marplan) and phenelzine (Nardil) -- are usually prescribed only after other medications have been tried. That is because MAOIs can have serious side effects. These antidepressants require a strict diet because of dangerous (or even deadly) interactions with foods such as certain cheeses, pickles and wines and with some medications including decongestants. Selegiline (Emsam) is an MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. Side effects aside, these medications are the antidepressants most proven to treat atypical depression. They may be effective when other medications, such as tricyclic antidepressants, do not work.

6)Other medications. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or anti-psychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication

Everyone is different, so finding the right medication or medications for you will likely take some work. If a family member has responded well to an antidepressant, it may be one that could help you. You may need to try several medications before you find one that works. This can require patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, do not stop taking an antidepressant without talking to your doctor first.

Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Do not give up until you find an antidepressant or medication that is suitable for you -- you are likely to find one that works and has tolerable side effects.

If antidepressant treatment does not seem to be working, your doctor may recommend a DNA test to check for specific genes that affect how your body uses antidepressants. Cytochrome P450 genotyping tests may be able to help predict how well your body will processes (metabolize) a medication. This may help guide your doctor in identifying an antidepressant that is likely to work for you and cause the fewest side effects. Genetic tests are new, so they are not widely used yet. It is not clear how well they work to predict which antidepressant is likely to work best.

Antidepressants and pregnancy

If you are pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk

Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) warns that children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Psychotherapy

Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Psychotherapy sessions can help you:

1)Learn about the causes of depression so that you can better understand how to cope with it
2)Learn how to identify and make changes in unhealthy behavior or thoughts
3)Explore relationships and experiences that could be linked to feelings of depression
4)Find better ways to cope with stressful situations and solve problems
5)Set realistic goals
6)Regain a sense of happiness and control in your life
7)Improve depression symptoms such as hopelessness and anger
8)Help you cope with a crisis or other current difficulty

There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones. It is based on the idea that your own thoughts -- not other people or situations -- determine how you feel or behave. Even if an unwanted situation does not change, you can change the way you think and behave in a positive way. Interpersonal therapy, psychodynamic psychotherapy, and acceptance and commitment therapy (ACT) are other types of counseling commonly used to treat atypical depression and other types of depression.

Hospitalization and residential treatment programs

In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you are not able to care for yourself properly or when you are in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These outpatient programs provide the support and counseling you need while you get symptoms under control.

Adopted from mayoclinic.com