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Atypical Depression More Common in People with Bipolar


A bipolar patient experiences symptoms of atypical depression.Most people think depression is one thing. People think when people are “depressed” they are sad, fatigued, and maybe a few other things. But, in fact, a person with depression can have several of a list of symptoms and many people experience depression differently.

For example, one person who is depressed may experience sadness, fatigue, a decrease in appetite, an inability to make decisions, and insomnia, while another person with depression may experience sadness, excessive sleep, an increase in appetite, psychomotor agitation and an inability to concentrate.

Between these two people some of the symptoms are actually opposites and yet they both are experiencing depression.

Depression Subtypes

How can this be?

Well the answer to that is just one of the reasons why psychiatry is so complicated. There are several known subtypes of depression that all carry a specific symptom profile. One of these depression subtypes is known as atypical depression and this form of depression is more common in people with bipolar disorder, particularly bipolar type II.

Atypical Depression

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), atypical depression is a subtype of depression that requires:

  • Mood reactivity (ie. the mood brightens in response to events)
  • Two or more of the following:
    • Significant weight gain or an increase in appetite
    • Hypersomnia (over-sleeping)
    • Leaden paralysis (ie. a heavy, leaden feeling in the arms and legs)
    • The criteria not be met for depression subtypes “with melancholic features” or “with catatonic features” during the same episode

Those with bipolar depression often share the following characteristics with those with atypical depression:

  • Longer duration of illness
  • More frequent episodes
  • Common occurrence of the “leaden paralysis” symptom
  • Common occurrence of hypersomnia

But why care about atypical versus typical depression? Well, there are two reasons:

  1. As I stated, atypical depression is more common in people with bipolar disorder and some doctors consider it a “soft sign” of bipolar disorder. (In other words, if you have atypical depression, it’s worth considering whether you really have bipolar depression and not unipolar depression.)
  2. The subtype of depression can help indicate the appropriate course of treatment.

Atypical Depression Treatment

Unfortunately, atypical depression treatment with antidepressants has been the primary area of study, and in many cases this type of treatment is contraindicated in people with bipolar disorder. Nevertheless, here’s what we’ve learned:

  • Monoamine oxidase inhibitors (MAOIs) have been found to be superior to tricyclic antidepressants (TCAs) in treatment.
  • People with atypical depression may have a less robust response to electroconvulsive therapy (ECT).
  • Selective serotonin reuptake inhibitors (SSRIs) are considered more effective than TCAs and are more well-tolerated than MAOIs.
  • Depression-specific cognitive behavioral therapy (CBT) has been shown effective.

Keep in mind that other treatments (like mood stabilizers) may be effective, there just isn’t available research in that area.

Atypical vs. Typical Depression

I admit that for any one individual, all that matters is that he or she is depressed and that he gets well again. Nevertheless, understanding what is known about an illness can help chart the best treatment and give us greater insight into our own experiences.

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