Newsweek Mental Health - Atypical Depression

Depression Update: Atypical Depression
by Jeffrey Paul Kahn, M.D.

Not everyone realizes that there are many different kinds of depression. Recently, there has been a growing awareness of one kind called atypical depression. Perhaps the most common kind of depression around, it is called atypical because many of its symptoms are opposite to those of some severe depressions, where people can't eat, can't sleep and can't smile.

Symptoms

Depressed mood often lasts for years, starting in teens or twenties.
Mild to moderate depressed mood comes and goes in cycles.
Depressed mood can lift during the depressive phase, though only temporarily.
Decreased energy level, often feeling physically lethargic, at times feeling unable to move.
Increased sleep time (given the chance), sometimes with trouble falling asleep as well.
Increased appetite, often with cravings for sweets, chocolates or carbohydrates.
Increased emotional sensitivity to personal slights, criticisms, rejections.

All symptoms don't have to be present. Some aren't aware of how depressed they are, because they feel that way most of the time. Other people instinctively compensate for the symptoms: they diet, they stay on a rigid sleep schedule, push themselves to overcome their lack of energy and they study their relationships carefully to protect against possible rejections.
People who have atypical depression are at higher risk for a more serious and sudden major depression. Atypical depression often occurs together with panic disorder (a common anxiety disorder) and can be accompanied by problems with drug or alcohol abuse.

Causes & Effects
Atypical depression has a major effect on the way people lead their lives. Excessive sensitivity to personal slights can make it difficult to develop close relationships. Even friendly constructive criticism at work can feel like overwhelming rejection. The lack of energy and the depressed mood can make going out to a movie seem like too much trouble. Depressive phases are often set off by real or perceived rejections. When a romance falls apart, it can easily trigger serious symptoms.

Medication
Once the right diagnosis is made, treatment is straightforward these days. Medication is usually very effective in controlling the symptoms. The most effective medications are probably the SSRI (selective serotonin reuptake inhibitor) antidepressants, including fluoxetine, sertraline and paroxetine. They all take a month to start working, finding the right dose might take a little longer, and sometimes a second medication is used as a booster.

Psychotherapy
Medication works best in combination with the right psychotherapy, which becomes most effective after the medication has started to work. At that point, it gets easier to understand how symptoms have affected relationships and life patterns. With more energy and less sensitivity, people are often able to improve their social and work lives. Feeling more cheerful and energetic than before is unfamiliar for many people, so feeling better can also lead to anxiety. Some who respond best to medication are those who have had quality psychotherapy in the past. Once the depression lifts, the lessons learned from past psychotherapy suddenly sink in.

Taking Action
People who have been feeling depressed for a long time, or who have a serious depression now, might want to see a psychiatrist for consultation. Make sure it is someone who comes well recommended, and who is familiar with atypical depression. A good psychiatrist can help sort out different kinds of depression, anxiety, medical problems and life stresses. Feeling depressed often has more than one cause. Once the right causes are found, the odds of finding the right treatment are good.

Dr. Kahn is a Manhattan psychiatrist, and president of WorkPsych Associates, Inc., a mental health and executive consulting firm. He is also past president of the Academy of Organizational and Occupational Psychiatry, and teaches on the psychiatric faculty of Cornell University Medical College.