Depression is associated with insomnia, decreased appetite and long-lasting depressed mood, but in reality, depressive disorders do not have to take such a course. A particular mood disorder is atypical depression. What distinguishes it from typical depression, what are its symptoms and is the treatment of atypical depression different from treatment of classic depression?

Contents:

  1. Typical and atypical depression: how often do they occur?
  2. Typical and Atypical Depression: Basic Differences
  3. Typical and atypical depression: symptoms
  4. Typical and atypical depression: recognizing
  5. Typical and atypical depression: treatment

Typical depression and atypical depression are the basic division of depressive disorders. Theoretically, it would seem that there must be clearly visible differences between them, but in practice it turns out that distinguishing typical from atypical depression is not so easy.

Depressive disorders are one of the most common entities of interest in psychiatry.

Apart from typical depression and atypical depression, there are also other types of depression - these include:

  • seasonal depression
  • anaclitic depression
  • masked depression
  • psychotic depression

Typical and atypical depression: how often do they occur?

Atypical depression was first discussed at the turn of the 1950s and 1960s. It was then that it was noticed that there was a group of patients with depression in whom the drugs commonly used in the treatment of this ailment - which were tricyclic antidepressants (TLPDs) - did not bring the expected results.

It was also observed that in some people depressive disorders lead to ailments other than typical for mood disorders.

With the passage of time, more conclusions were reached, and finally a set of symptoms characteristic of atypical depression was identified, and research was also started to estimate the exact frequency of its occurrence.

The prevalence of atypical depression in the general population may be much greater than it could be assumed - it is estimated that among all patients with depressive disorders, from 16% to even more than 30% of them may be theirsatypical character.

Various studies also show that atypical depression occurs up to three times more often in women than in men.

Typical and Atypical Depression: Basic Differences

Nowadays, we know more and more about the pathogenesis of depressive disorders - attention is paid to the role of genes in their occurrence and various environmental conditions.

The research carried out for years also allowed to obtain knowledge about the possible causes of typical and atypical depression and the differences between these problems. The differences concern not only the symptoms of typical and atypical depression, but also completely different aspects.

It turns out that in patients with these different types of depressive disorders, cerebral blood circulation may be affected: as in one study it was observed that in patients with typical depression there is an increased blood flow in the right occipital lobe, and weakened in the left frontal lobe, so in patients with atypical depression increased blood flow was visible in the right frontal lobe, and decreased flow in the occipital lobes of the brain.

Another difference between typical and atypical depression is the impact of these problems on the sleep pattern in patients: as in the case of classic depressive disorders, a shortening of the REM sleep phase latency is visible, and in people with atypical depression its course is comparable to the REM phase in people not burdened with mood disorders.

The levels of neurotransmitters in the central nervous system are of great interest to scientists dealing with the causes of depression - it has been known for a long time that their abnormal levels may most likely result in depressive disorders and other mental disorders.

In this case, as in patients with typical depression, abnormalities in the serotonergic and noradrenergic systems are clearly visible, so most likely in the course of atypical depression, the disorders related to neurotransmitters may only involve the serotonergic system.

Typical and atypical depression: symptoms

The symptoms of typical depression are well known - among them there are such problems as:

  • depressed mood
  • anhedonia (loss of happiness)
  • significant decrease in energy and motivation to act
  • deterioration of concentration and attention
  • guilt
  • low self-esteem
  • sleep disorders (primarily insomnia, difficulty falling asleep or waking up exceptionally early in the morning)
  • decreased appetite

There are, however, symptoms of atypical depressionslightly different - the most characteristic manifestations of this problem include:

  • mood reactivity (a necessary condition for the diagnosis of atypical depression, it can be understood as the ability of a depressed patient to feel joy and happiness after some positive stimuli appear in his / her life)
  • hypersomnia (excessive sleepiness, defined as sleeping 10 or more hours a day for at least 3 days a week)
  • hyperphagia (excessive appetite resulting in weight gain; a manifestation of hyperphagia in the course of atypical depression may be weight gain of 5 or more kilograms in three months)
  • heaviness (also known as heaviness in the body, repetitive bodily sensations like feeling paralyzed)
  • excessive sensitivity to rejection

Typical and atypical depression: recognizing

When diagnosing depression - whether typical or atypical - one should take into account the current diagnostic criteria (the conditions for recognizing both of these problems are included in both the ICD-10 and DSM-V classification).

However, special attention should be paid to patients with suspected atypical depressive disorders - careful diagnosis is necessary in them because other types of mental disorders often coexist with them.

Compared to typical depression, in the course of its atypical form, its coexistence with somatization disorders, substance abuse or panic disorder is noticeably more frequent.

Vigilance, however, should also be observed after the diagnosis of atypical depression - it turns out that more often than in patients with typical depression, it eventually leads to the fact that a person who was once diagnosed with atypical depressive disorder develops bipolar disorder in the future (BD) or seasonal depression.

Typical and atypical depression: treatment

In the past, electroconvulsive therapy was considered to be ineffective in treating atypical depression.

In later studies, however, it turned out that this was not necessarily true, and that electroconvulsive shock can be effective in patients with the most severe forms of atypical depressive disorder.

However, other conclusions regarding the differentiation in the treatment of atypical depression turned out to be correct - it is noticeable to this day that it is difficult to improve the condition of patients with the use of tricyclic antidepressants, and therefore they are definitely notdrugs of the first choice in patients with this type of mood disorder.

However, the use of antidepressants from other groups can bring satisfactory results - there are reports of positive results in the treatment of atypical depression with moclobemide (which is a drug from the group of monoamine oxidase inhibitors, MAOIs) or agents affecting primarily the serotoninergic system (such as primarily inhibitors serotonin reuptake, or SSRI).

It is also worth mentioning that some authors suggest the need to take into account the risk of developing bipolar disorder in a patient with atypical depression.

Because when it is high or when the patient meets the criteria for recognizing this unit (symptoms of atypical depression may eventually be a symptom of a depressive episode in the course of bipolar disorder), he / she should not take antidepressants alone, but should take along with them mood stabilizing drugs (mood stabilizers).

In the treatment of atypical depression, fewer drugs are used than in the case of typical depression - in the case of the latter, the benefits may be obtained from the use of agents belonging to very different drug groups, because both SSRIs, TLPDs, as well as MAOIs or SNRIs (uptake inhibitors). serotonin and norepinephrine recirculation), as well as preparations with other mechanisms of action.

There is, however, one treatment method that is common to typical and atypical depression - psychotherapy, which can enhance the effects of pharmacotherapy in treating depression.

About the authorBow. Tomasz NęckiA graduate of medicine at the Medical University of Poznań. An admirer of the Polish sea (most willingly strolling along its shores with headphones in his ears), cats and books. In working with patients, he focuses on always listening to them and spending as much time as they need.

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Category:

Psychiatry