Depression Articles

What is depression? How does Atypical Depression differ from other types of depression? This article helps define Atypical Depression and contains information on the onset, symptoms, and treatment of Atypical Depression, including MAOIs and antidepressants.

The two clear things about atypical depression are that researchers aren’t sure what it is and that it is likely common. Read this article to find out more about the state of what is known about this disorder.

What Is Depression?

Depression is a mood disorder in which a person’s mood is pervasively sad and melancholy. Often this is accompanied by feelings of hopelessness, worthlessness, trouble sleeping, eating disturbances, fatigue, loss of interest in activities, and inability to make decisions.

How Is Atypical Depression Unique?

The name atypical suggests that this type of depression manifests certain differences from what’s expected. So what are those differences?

1. Onset: People with atypical depression have an earlier age of onset than people with other types of depression.
2. Symptoms: People with atypical depression often describe feeling weighed down. While in general, people with depression tend to have sleep and eating disturbances of various kinds including loss of appetite and insomnia, people with atypical depression most often overeat and oversleep. Atypical depression is also associated with a higher rate of suicidal thoughts and suicide attempts than other depressions. Another hallmark feature is an increase in sensitivity to rejection.
3. Mood consistency: In most forms of depression the overwhelming sadness is ongoing and unaltered by external events. In atypical depression, although the person is sad most of the time, his or her mood may be responsive to both positive and negative events in the person’s life.
4. Treatment: Many depressed people respond well to tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). Not so those with atypical depression. People with atypical depression often respond better to monoamine oxidase inhibitors (MAOIs).
5. Chronic course: Whereas depression in general may be episodic, atypical depression tends to be chronic.

Researchers’ Views on Atypical Depression

Experts are still not sure about defining characteristics of atypical depression. Some patients have most but not all of the defining characteristics. For example, a patient might have all of the characteristics mentioned, but have a reduced, rather than increased, appetite for food. Some researchers think that atypical depression may actually be a form of another mood disorder, either dysthymic disorder or cyclothymic disorder.

Dysthymic disorder, or dysthymia, is a chronic, low-level form of depression that has persisted for at least two years. Cyclothymic disorder, or cyclothymia, is a chronic, low-level form of bipolar disorder.

More About Treating Atypical Depression

Because the diagnosis of atypical depression is not agreed on or standardized, a patient presenting with symptoms of depression is most likely to be therapy and an antidepressant, and - if that isn’t effective - a second or third antidepressant, and/or combinations of antidepressants, because even in cases in which an antidepressant will turn out to be effective, it takes a number of adjustments to find the best pharmaceutical and dosage match. So, MAOIs are not likely to be the first line of treatment.

In addition, MAOIs can both cause  drug interactions with antidepressants (so they can’t be used together) and also with food. Food and drink containing tyramines must be avoided. Tyramine is a natural monoamine compound that is metabolized by monoamine oxidase, which MAOIs inhibit. If such foods are eaten while taking a course of MAOIs, a person can have a harmful rise in blood pressure and increased heart rate, possibly resulting in a hypertensive crisis. So people taking MAOIs must be diligent in checking their food, and this places an extra burden on the patient, another reason that they may not be quickly prescribed.

Lists of foods to avoid, even on expert sites, all hedge their descriptions, saying things like “foods to avoid may include” the following items. It is not clear why. Foods that make the lists include: aged cheeses; alcoholic products; avocadoes; bananas; fermented foods, including sauerkraut, and fermented soy products; foods that could possibly be spoiled, including foods that look fine but have passed their freshness date; processed meats including sausage and salami; yeast extract spreads like Marmite and Vegemite, and any foods that might include one or more of these.

Sources

webmd.com
pn.psychiatryonline.org
mayoclinic.com