I like the DSM-5 and I think it provides us with a conceptual framework for evaluating patients. In clinical practice it’s rare to find patients that fit all diagnostic criteria perfectly. When that does occur it’s nice and makes life easy.
Major depressive disorder with atypical features is one of those situations. Many patients have some of the symptoms but not enough to clearly make the distinction. Nonetheless, some of these symptoms are common and need to be discussed.
What makes this type of depression atypical?
I like to think of the symptoms as the opposite or reverse of major depression discussed in previous posts.
A key distinction to look for is mood reactivity in response to positive events. In major depressive disorder nothing usually makes the patient feel happy. They may even present with a restricted, constricted or blunted affect. In the atypical case, these patients can react and show emotion when positive events occur.
Along with mood reactivity, they must have two of the following features:
- Increased appetite or significant weight gain
- Hypersomnia (excessive sleep)
- Leaden paralysis often described as a heaviness of the arms and legs
- A longstanding pattern of sensitivity to interpersonal rejection
- It must be impairing social and occupational function
When you look at the list above you see why we can think of these symptoms as the opposite of typical major depression.
Hope this post helps to clear up some question about atypical depression. Please like, share and comment.
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