Living with Atypical Depression
Despite its name, atypical depression isn’t some rare or bizarre condition. According to research data compiled by the Depression and Bipolar Support Alliance (DBSA), atypical depression is the most commonly diagnosed subcategory of major depression. What we’ve come to think of as “typical” depression more closely resembles the subcategory known as melancholic depression.
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, or DSM-IV, makes a distinction between atypical and melancholic depression. The defining feature of melancholic depression is a loss of pleasure in normally enjoyable activities: the patient can’t be cheered up by good news or positive attention from loved ones. Someone suffering from melancholic depression often experiences a significant weight loss or decrease in appetite and may wake up too early in the morning.
By contrast, atypical depression is characterized by “mood reactivity”: the depression lifts when good things happen and deepens in response to negative events. In addition to mood reactivity, a diagnosis of atypical depression requires the presence of at least two of the following symptoms: an increase in appetite or significant weight gain; sleeping for at least 10 hours per day (hypersomnia); a feeling of extreme lethargy or heaviness (leaden paralysis); and a history of extreme reactions to perceived rejection (rejection sensitivity).
I’ve lived with atypical depression since I was 14. I didn’t know then that “depression,” atypical or otherwise, was the name for my dark moods and lack of energy, and neither did any of the adults in my life. This was the early 1980s, before the advent of Prozac and other popular antidepressant medications, before the explosion of books about clinical depression, before the Internet with its wealth of information on mood disorders. I was a teenager-how could anyone tell whether my grouchiness, sadness, and lethargy were normal adolescent growing pains or signs of illness? I was a straight-A student; I wasn’t comfortable socially, but I didn’t drink or do drugs or sleep with boys. How did a mood disorder fit into this picture?
The depression grew worse as I got older, the episodes becoming more frequent and more intense. Throughout college, I sat weeping through weekly sessions with my kindly, bearded psychotherapist. He truly believed that love and empathy would cure me. The term “atypical depression” certainly never came up; but I did broach the subject of antidepressant medication. It was by now the early nineties, when the media had already glorified and then vilified Prozac. “Sorry, kiddo,” my therapist smiled. “You’ll have to do it on your own.” I got the same message from other clinicians around that time: psychotherapy ought to suffice for someone who was functioning well enough to make the Dean’s list nearly every semester. So what if there were periods when I slept for 12 hours a day, sat in front of the TV for the other 12, ate nothing but cheeseburgers and donuts, and contemplated suicide every time a boy rejected me? Antidepressant medication must be for really sick people, I thought. Not for me.
I was 26 before I was finally diagnosed with depression, though neither my new psychotherapist nor my psychiatrist said anything about atypical depression. This therapist supported my decision to start taking antidepressant medication. At last, I got my hands on the longed-for Prozac; within a month, the depression was gone. It was such an amazing turnaround that I suddenly wanted to learn all I could about depression, and I began reading everything I could find on the subject. To my surprise, I discovered that “depression” was a general term, and that even my diagnosis of Major Depressive Disorder wasn’t quite specific enough. There were different “subtypes” of depression, and I wanted to know which one applied to my condition.
One day, I came across a concise description of atypical depression and was astonished: during my depressive episodes, I had had all of the symptoms. Mood reactivity: check. Increased appetite: check. Hypersomnia: check. Leaden paralysis: check. Rejection sensitivity: double-check. This was the one symptom which Prozac had not vanquished; the smallest criticism still had the power to ruin my day. I read that rejection sensitivity, unlike the other aspects of atypical depression, tended to appear early in life and continued into adulthood whether one was actively depressed or not. I’d never heard the term “rejection sensitivity” before; I didn’t know that other people-many people-were fragile in the same way I was, or that this fragility might have biochemical underpinnings.
For me, realizing that I have atypical depression has not in itself been a saving grace. I still struggle with rejection sensitivity, although my reactions at age 35 are far more reasonable than they were at 14 or 26. Prozac’s first bloom eventually faded, as it does for many people. I have since switched antidepressant medications several times, finally settling on Wellbutrin, which has worked well for the past four years. Unfortunately, the type of depression doesn’t point to a clear choice of treatment. Researchers don’t really know how antidepressant medications work; they don’t know why some work for certain people and not for others. People with any form of depression could benefit from the same medications that have helped me. And in my view, a good psychotherapist and a healthy lifestyle are every bit as important to recovery as is medication. In other words, I haven’t sought out particular treatments for atypical depression. The things which have helped me have helped millions.
So what’s in a name, a label made of psychiatric jargon? I’m a writer, and the names of things hold great meaning for me. Naming my condition meant that all of my strange symptoms weren’t “just me.” Looking at that clunky clinical terminology, I see myself, and see that there are others like me. My atypical depression isn’t really atypical at all, and neither am I.