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Successful at work, everyday life under control, social environment intact – and still depressed. Atypical or high-functioning depression often goes undiagnosed for years because those affected do not dare see a doctor. You don’t feel “sick enough.” People with an atypical depression cope with their everyday life quite well – and still suffer.

Atypical depression at a glance

Atypical or high-functioning depression does not follow a “typical” presentation of a depressive disorder. In general, sufferers experience similar symptoms to those with Major Depressive Disorder (MMD), but with one key difference: mood reactivity. In other words, a person’s mood can improve as soon as something positive happens.

Atypical depression, now referred to as depressive disorder with atypical features, is common. Unlike other forms of depression, people with atypical depression may respond better to antidepressants called monoamine oxidase inhibitors (MAOIs). MMD with atypical symptoms is often diagnosed in the teenage years.

Symptoms of atypical depression

In addition to the core symptoms of depression, people with atypical depression may also experience the following symptoms:

  • The mood lifts temporarily after a positive event or good news
  • increased appetite and weight gain
  • Feeling of heaviness in arms or legs
  • body aches
  • increased need for sleep at night or during the day (hypersomnia)
  • extreme sensitivity to rejection or perceived criticism

Less common symptoms are:

  • Insomnia – headaches – eating disorders

The phase of tiredness is often bridged with concentration tablets

Possible causes of atypical depression

The exact reason why some people suffer from atypical depression is not known. A possible cause of atypical depression is an imbalance in certain neurotransmitters, including dopamine, serotonin, and norepinephrine, which affect mood.

Other factors that may increase your risk of atypical depression include:

  • Family history: You are more likely to have symptoms of atypical depression if others in your family also have depression or another type of mood disorder.
  • Certain medical conditions: If you have a history of bipolar disorder, anxiety disorders, body dysmorphic disorder, or social phobia, you are more likely to develop atypical depression.
  • Substance use: A history of substance use or abuse can increase the likelihood of depression.


Getting a correct diagnosis is crucial in getting the treatment you or your loved ones need. Unfortunately, unlike other health conditions, there is no laboratory test, x-ray, or physical exam to provide a definitive diagnosis.

An informed diagnosis involves specific testing to rule out any health conditions causing symptoms of depression and maybe an underlying cause. This may include a blood test, drug test, and imaging tests (C.T. scan or M.R.I. of the brain).

A depression test is also often used, which can be performed during the assessment by a doctor or mental health professional, on paper, or with a digital device. The doctor compares your responses and symptoms to the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

According to the DSM-5, sufferers with depressive disorder and atypical symptoms must demonstrate the ability to transiently feel better in response to a positive life event (mood reactivity) plus two of the following criteria for a period of two or more weeks:

  • overeating or weight gain – the noticeable need for sleep
  • Fatigue, weakness, and a feeling of heaviness – intense rejection sensitivity
  • strongly reactive moods

Treatment of atypical depression

Although selective serotonin reuptake inhibitors (SSRIs) and other newer drugs are the first choices for treating depression because of their favorable side effect profile, patients with atypical depression tend to respond better to monoamine oxidase inhibitors (MA01s).

Some common M.A.O. inhibitors are:

  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Isocarboxazid (Marplan)
  • Selegiline (Emsam)

Still, SSRIs may be prescribed first because they don’t have the potential for serious side effects or dietary restrictions. For example, to avoid potentially fatal high blood pressure fluctuations, it is necessary to avoid foods and beverages high in tyramine while taking MAOIs.

Psychotherapy or talk therapy are also important parts of the treatment plan. Cognitive-behavioral therapy (C.B.T.) has been scientifically proven to be effective in treating symptoms of depression.

C.B.T. can help you resolve stressful situations, deal with negative thoughts and emotions, and manage your fears. These skills are especially helpful when people wait for their prescribed antidepressants to take effect.

Other types of psychotherapy or talk therapy that can be used for atypical depression include:

  • behavior therapy
  • cognitive therapy
  • Dialectical Behavior Therapy
  • The individual, group, and family therapy – psychodynamic therapy

Alternative programs

In addition to medication and psychotherapy, some preliminary studies show that certain herbs and supplements may also help with symptoms of depression. These include fish oil, St. John’s Wort, 5-HTP, and folic acid. If you are considering supplements, talk to your doctor first. Some supplements and herbs could interfere with the medication.


Coping with atypical depression

If atypical depression interferes with your daily activities, working with your doctor to develop a treatment plan that includes medication and psychotherapy is a good first step. In addition, there are lifestyle modifications that can help relieve symptoms and help you manage them better.

  1. Prioritize diet and exercise. Sticking to a healthy diet and exercising will improve your overall health and reduce the symptoms of atypical depression to the best of your ability.
  2. Practice mindfulness meditation and deep breathing. Breathing exercises combined with mindfulness meditation can teach you to become aware of your thoughts and feelings without reacting to them.
  3. Write a diary. Journaling or expressive writing is a highly recommended tool for dealing with depression. Whether you do it daily or weekly, it can help you explore your feelings and counteract many of the negative effects of stress.
  4. Ask for support. Having strong social support is perhaps the most important thing you can do to help cope with depression.
  5. To deal with This may include trusted family members and friends or an online or in-person depression group to share your feelings and experiences.


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