Depression is often associated with the inability to find pleasure in anything, including situations and activities one typically would enjoy in the absence of the illness. For a significant subset of people with depression, however, the defining clinical feature is an improvement in mood in response to certain events, such as a visit from friends or a promotion at work. This specific type of the disorder — atypical depression — affects an estimated 15% to 40% of patients with depression,1 and rates are higher among women than men.1,2
In the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), atypical depression is a specifier to major depressive disorder (MDD) and persistent depressive disorder (PDD; formerly called dysthymic disorder) that denotes the presence of certain symptoms in addition to those required for a diagnosis of MDD or PDD.
In addition to that hallmark feature of situational mood improvement, a diagnosis of atypical depression requires two or more of the following additional symptoms: a sense of physical heaviness, oversensitivity to interpersonal rejection or perceived criticism, increased appetite, weight gain, and excessive sleeping.3
Atypical depression may not be as well known as some of the other specifiers, such as peripartum onset and seasonal pattern (including seasonal affective disorder). Practitioner awareness of this subsyndrome is important, however, particularly because people with atypical depression appear to be at higher risk than others for co-occurring health problems, including other psychiatric disorders. They also have more frequent suicidal thoughts and more disability days than do those with non-atypical depression.1