Atypical Depression Mood Swings
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Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms vary from the traditional criteria. One symptom specific to atypical depression is a temporary mood improvement in response to actual or potential positive events. This is known as mood reactivity.
Depression is quite prevalent, affecting approximately 121 million people worldwide. Despite its name, atypical depression is actually quite common affecting 18 to 36% of people with a depressive disorder.
Atypical depression is at least twice more likely to affect women than men. In addition, atypical depression tends to begin at an earlier age (teen years and early 20s) and last longer (often becoming a chronic condition) than typical depression.
These symptoms differ from typical depression symptoms, which often include a loss of appetite and insomnia (difficulty falling and/or staying asleep). In addition, the mood of people with typical depression usually does not improve, even when good things happen.
Diagnosis of atypical depression is made based upon an evaluation of your symptoms. A doctor will perform a physical exam to rule out physical causes of depressive symptoms such as a thyroid disorder. He or she will ask if you have a family history of mental health issues or depression. Your doctor will also ask about your behaviors and feelings and may refer you to a behavioral health specialist (psychologist or psychiatrist) for diagnosis and treatment.
Depression is a mood disorder that causes feelings of sadness that won't go away. Unfortunately, there's a lot of stigma around depression. Depression isn't a weakness or a character flaw. It's not about being in a bad mood, and people who experience depression can't just snap out of it. Depression is a common, serious, and treatable condition. If you're experiencing depression, you're not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It's really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That's why it's important to get an accurate diagnosis.
While there's no single cause of depression, most experts believe there's a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.
Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. Also called major depressive disorder or clinical depression, it affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn't worth living.
Atypical depression is a subtype of major depression or dysthymic disorder that involves several specific symptoms, including increased appetite or weight gain, sleepiness or excessive sleep, marked fatigue or weakness, moods that are strongly reactive to environmental circumstances, and feeling extremely sensitive to rejection.
Atypical depression can be a "specifier" for either major depression or dysthymic disorder. People with atypical depression have often experienced depression first at an early age, during their teenage years.
Dysthymic disorder, now known in the psychiatric community as "persistent depressive disorder" or chronic major depression, is a condition involving the presence of a depressed mood more days than not for at least a two year period in adults (one year in children and adolescents) plus at least two of the above associated symptoms, but fewer than the five symptoms which define a major depressive episode.
Despite its name, atypical depression is very common. It is contrasted with "melancholic" depression, another subtype of depression, involving symptoms of insomnia (rather than oversleeping), loss of appetite (rather than increased appetite), a relative lack of mood reactiveness to environmental circumstances, and a markedly diminished ability to feel pleasure.
One of the main characteristics of atypical depression that distinguishes it from melancholic depression is mood reactivity. In other words, the person with atypical depression will see their mood improve if something positive happens. In melancholic depression, positive changes will seldom bring on a change in mood. In addition, diagnostic criteria call for at least two of the following symptoms to accompany the mood reactivity:
Doctors are likely to recommend psychotherapy (talk therapy) and/or medications for atypical depression, depending on the severity of the symptoms. There are different types of psychotherapy and medications available for treatment. You may be referred to a specialist such as a psychiatrist, psychologist, or other licensed mental health professional for care.
Objective: Recent data, including our own, indicate significant overlap between atypical depression and bipolar II. Furthermore, the affective fluctuations of patients with these disorders are difficult to separate, on clinical grounds, from cyclothymic temperamental and borderline personality disorders. The present analyses are part of an ongoing Pisa-San Diego investigation to examine whether interpersonal sensitivity, mood reactivity and cyclothymic mood swings constitute a common diathesis underlying the atypical depression-bipolar II-borderline personality constructs.
Results: Seventy-eight percent of atypical depressives met criteria for bipolar spectrum-principally bipolar II-disorder. Forty-five patients who met the criteria for cyclothymic temperament, compared with the 62 who did not, were indistinguishable on demographic, familial and clinical features, but were significantly higher in lifetime comorbidity for panic disorder with agoraphobia, alcohol abuse, bulimia nervosa, as well as borderline and dependent personality disorders. Cyclothymic atypical depressives also scored higher on the ADDS items of maximum reactivity of mood, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the interpersonal sensitivity, phobic anxiety, paranoid ideation and psychoticism of the HSCL-90 factors. The total number of cyclothymic traits was significantly correlated with 'maximum' reactivity of mood and interpersonal sensitivity. A significant correlation was also found between interpersonal sensitivity and 'usual' and 'maximum' reactivity of mood.
Conclusions: Mood lability and interpersonal sensitivity traits appear to be related by a cyclothymic temperamental diathesis which, in turn, appears to underlie the complex pattern of anxiety, mood and impulsive disorders which atypical depressive, bipolar II and borderline patients display clinically. We submit that conceptualizing these constructs as being related will make patients in this realm more accessible to pharmacological and psychological interventions geared to their common temperamental attributes. More generally, we submit that the construct of borderline personality disorder is better covered by more conventional diagnostic entities.
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
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
The New South Wales University group also defined AD as chronic, mild, non-endogenous (non-melancholic) unipolar depression, but indicated the predominance of anxiety symptoms over mood symptoms and the significance of interpersonal rejection. Parker et al14 argued that mood reactivity did not show specificity with any other four criterion symptoms and claimed that anxiety may be more specific and common in AD.
The percentage of AD found in the GENDEP (Genome-based Therapeutic Drugs for Depression study was 7.4.37 In the outpatients studied in the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) trial, 18.1% had depression with atypical features.38 In a community sample of young adults (Zurich cohort study), the cumulative incidence rates of various types of depression were as follows: melancholia or AD (in one group), 4.1%; pure melancholia, 7.1%; pure AD, 3.5%; and unspecified depression, 8.2%.17 2b1af7f3a8