Types and methods of treatment for atypical depression

Atypical depression is a separate type of psycho-emotional disorder, which is characterized by a combination of typical depressive symptoms and some specific signs. The leading manifestations of atypical depression: emotional reactivity, excessively increased appetite, weight gain, increased drowsiness.

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Despite the fact that atypical depression is a widespread disorder today, a clear cause of its occurrence and an accurate prognosis for its development have not been established. Conducted scientific research puts forward several versions about its nature. Some experts classify atypical depression as a subtype of dysthymia, while another group of scientists believes that this illness is a mild variant of bipolar affective disorder. The lack of a common understanding of the nature of the disease and sufficient clinical data on the mechanisms of development create certain difficulties in diagnosing the pathology, its differentiation from other depressive disorders and its treatment.

The International Classification of Diseases (ICD-10) classifies atypical depression under “other depressive episodes” and recommends that diagnosis be based on the presence of somatic symptoms that do not have organic causes. According to DSM-IV, a diagnosis of “atypical depression” can be made if the patient has emotional reactivity (increased susceptibility of the subject to the influence of external stimuli), in combination with at least two of the following manifestations:

• increased appetite;
• weight gain;
• pathological drowsiness;
• feeling of heaviness in the lower extremities;
• significant impairment of social functioning as a result of increased reactivity to interpersonal problems.

Course of the disease

Despite the fact that this is a fairly common disease nowadays, the true causes of its occurrence are not fully understood. It is assumed that atypical depression appears against the background of a mental disorder and classic depression.

According to international medical standards, this diagnosis is given to people with emotional passivity in combination with 2 or all of the following symptoms:

• uncontrolled appetite;
• weight gain;
• poor sleep;
• weakness in the lower extremities;
• decrease or complete loss of social activity, accompanied by problems in personal life.

Classification

Each patient will have their own “set” of symptoms. Depending on this, there are several variants of atypical depression, I examined each of them in detail in previous articles:

• anxious;
• asthenic;
• apathetic;
• depression with delirium;
• anesthetic;
• hysterical;
• hypochondriacal and others.

Masked depression, described in more detail in this article, also belongs to the category of atypical depression.

Possible reasons

There are 2 main groups of causes of atypical depression: biological and psychological.

Biological reasons include:

• changes in the normal levels of brain chemicals responsible for brain activity;
• hereditary factor;
• taking various antidepressants, steroid hormones and painkillers;
• hormone deficiency and hormonal imbalance;
• viral infections that cause brain damage;
• severe long-term illnesses that cause prolonged immobility of the patient, as well as physical and emotional suffering;
• alcohol and drug abuse.

Psychological reasons:

• mental characteristics of a person;
• constant stress and nervous disorders;
• life misfortunes: death of a loved one, separation from a loved one, rape, loss of a job, bankruptcy, etc.;
• long-term stay in an unusual environment (forced loneliness, limited space, isolation from the outside world at one’s own request, etc.);
• improper upbringing of a child (oppression, humiliation, excessive severity, constant scandals in the family, etc.);
• lack of self-confidence, various personal complexes, constant feelings of guilt.

Psychological help

Treatment of atypical depression is impossible without providing the sick person with moral support. People who are depressed react painfully to any external stimuli. The main goal of providing psychological assistance is to overcome the negative perception of everything around you.

For this purpose, there are basic recommendations for providing such assistance:

• Understanding. A depressed person should not feel guilty for being in a bad mood. In addition, it is important to refrain from judging the patient and not try to “dig” into his condition.

• Optimism. Such people are prone to negative perceptions of everything around them. It is important to unobtrusively show a person the positive aspects of life.
• Instilling self-confidence. One of the symptoms of atypical depression is pathological self-doubt. It is necessary to show such a person that there are things that he does best.
• Everyday feasible assistance. A sick person may find it difficult to get the mood to do routine tasks, such as cooking or cleaning, and this depresses him. It is necessary to provide all possible help and encouragement. In this case, a person can feel needed for other people.
• Do not react to aggressive behavior. The patient is unable to control his own emotions, so he can often lash out at others. It is important not to react to such manifestations, but to take unpleasant conversations in a different direction.

Not only loved ones, but also professional psychologists and psychiatrists should assist in recovery.

Symptomatic manifestations

With atypical depression, the symptoms are very diverse and manifest themselves individually in each case.

The most common ones are the following:

• constant feeling of hunger;
• sleep disturbance - drowsiness during the day and inability to sleep at night;
• a haunting feeling of anxiety;
• powerlessness and lethargy;
• apathy;
• hot temper;
• imaginary diseases of internal organs (head, heart, kidneys, stomach, etc.);
• sexual disorders;
• fear of death due to illness, accident, accident;
• rapid weight loss or weight gain;
• a feeling of guilt for the actions committed, fear of inevitable punishment for them, etc.;
• inappropriate reaction to ordinary situations.

What it is?

There are such types of depression: typical and atypical. The first variety has classic symptoms:

• depressed state;
• feeling of hopelessness;
• lack of positive emotions from favorite activities;
• irritability;
• difficulties in making decisions;
• tearfulness;
• sleep disorders;
• decreased sex drive;
• mood swings;
• decreased appetite;
• thoughts about suicide.

Typical depression is easy to recognize because changes in a person's behavior are most noticeable. Atypical depression is a more insidious disease because its symptoms are not specific. Individuals who have already suffered the classic form of the disease in the past are more susceptible to this condition. Doctors are also considering the possibility that this type of depression may be a subtype of bipolar personality disorder or manic-depressive psychosis. Typical and atypical depression is a direct reason to seek qualified medical help.

Classification of types of atypical depression, their treatment

There are certain criteria that allow us to classify this condition into the following types of depression:

1. Anxious.
2. Masked.
3. Apathetic.
4. Asthenic.
5. Hysterical.
6. Depression with delusions, etc.

Anxious depression, by definition, involves persistent feelings of worry, worry, and fear. Most often it occurs against the background of long-term emotional and mental influences: an unfavorable situation in the family (quarrels, conflicts, humiliation from family members, etc.), a stressful working day without proper rest, life’s troubles, etc.

Characterized by the following features:

• tachycardia and tremor of the limbs;
• pressure surges;
• obsessive thoughts about threatening danger;
• indecisiveness in important situations;
• inferiority complex, lack of self-confidence;
• agitation and increased tearfulness;
• sleep disturbance;
• various phobias.

Anxious atypical depression is treated with medication and courses of psychotherapy. Antidepressants (Fluvoxamine, Sertalin, Paroxetine) and tranquilizers (Lorazepam, Clonzepam, Phenazepam) are prescribed as symptomatic drugs. Psychotherapy is aimed at relieving anxiety and bad thoughts, improving the patient’s psycho-emotional state.

Masked depression is hidden behind the manifestation of symptoms of other somatic or neurological ailments. It can be:

• vegetative-vascular dystonia;
• pathologies of the spine (osteochondrosis, vertebral hernia, radiculitis);
• cardiac dysfunctions (cardioneurosis, arrhythmia, tachycardia);
• intestinal pathologies;
• migraine;
• skin diseases.

All these diseases are accompanied by anxiety, panic attacks, neurasthenia, behavioral changes, and sleep disorders. Venlafaxine, Flesinoxan, Fluoxetine are used as therapy. Need help from a psychologist.

Apathetic depression is a mental disorder expressed in the patient’s indifference to life and decreased emotionality. The causes are the same as for the anxious form of depression.

Characteristics:

• lack of meaning in life, any goals and aspirations, all tasks and responsibilities are performed automatically, without interest;
• speech and facial expressions are unemotional;
• slowness;
• a person stops taking care of his appearance and clothes.

Antidepressants are prescribed to increase activity and vitality. The patient must be isolated from the harmful factors that caused this condition. One of the manifestations of apathetic disorder may be winter depression caused by weather changes, cold weather, etc.

Atypical depression of an asthenic nature manifests itself in the form of mental and physical exhaustion due to prolonged stress on the psyche.

Expressed in the following manifestations:

• decreased activity, lethargy and reluctance to do anything;
• excessive fatigue and exhaustion;
• physical weakness;
• poor tolerance to various irritating factors (loud speech or music, bright light, stressful situations, illness, etc.), increased tearfulness and cowardice.

The main feature of asthenic depression is the manifestation of all the above symptoms in the morning, after sleep. In many cases, this condition goes away in the evening. Treatment is with antidepressant medications and sedative herbal medicine.

Hysterical depression is a type of depressive disorder that manifests itself in the emotional exaggeration of a situation and display of feelings. Accompanied by some depression and slowing of motor functions. The most common reason is the loss of a loved one (death, quarrel, divorce).

It is characteristic that people susceptible to this disorder:

• everyone is described in detail their emotional state and grief;
• complain of physical and mental pain, sometimes very figuratively (a needle, a knife, a nail or thorns in the heart, a stone in the soul, etc.);
• experience various visions: of deceased loved ones, spirits, etc.;
• lose sleep and appetite.

Treatment of hysterical disorder is carried out comprehensively, depending on the symptoms, antidepressants, antipsychotic drugs, and psychotherapy are prescribed.

Atypical depression with delusional ideas (feelings of guilt, false shame, fear of non-existent diseases) has pronounced symptoms. The patient's condition is very anxious and agitated, there is a risk of suicide. Treatment for this type of depression is carried out only in a hospital.

Postpartum depression occurs against the background of happy motherhood, in the absence of visible factors that caused the malaise, usually due to hormonal changes in the body, impaired metabolism, pathology of the thyroid gland, painful breastfeeding (cracks, pain), deterioration in figure, changes in sexual life , material problems, etc.

Main symptoms:

• increased feelings of anxiety and concern;
• frequent tearfulness;
• loss of sleep;
• decreased appetite;
• causeless mood swings;
• fear that something will happen to the child;
• physiological disorders: tachycardia, dizziness, loss of strength, weight loss;
• panic attacks;
• feeling of uselessness and worthlessness.

The danger of this neurological ailment lies in the fact that it is often mistaken for fatigue from caring for a child, or melancholy due to a change in the usual lifestyle and routine. In the absence of proper treatment, this illness can last from several months to several years, gradually worsening and turning into severe mental forms of depression.

Noteworthy: postpartum depression can also affect men. Most often this is due to changes in family structure and lifestyle, increased responsibility for the child, financial problems or disruption of sexual life. Treatment consists of prescribing antidepressants containing serotonin, sedatives, and hormone therapy.

Diagnostics

• Clinical Criteria (DSM-5)
• Measurement of CBC, electrolytes, TSH, vitamin B12 and folate to exclude medical disorders that may cause depression

Diagnosis of depressive disorders is based on the identification of symptoms, signs and clinical criteria described above. Depressive disorders are distinguished from normal mood swings by the presence of significant physical discomfort or problems in social, occupational, and other areas of functioning.

Brief questionnaires have been developed for screening. They can be used to identify some depressive symptoms, but the diagnosis cannot be based on survey data alone. Some yes or no questions can help determine whether a patient has symptoms that meet DSM-5 criteria for a diagnosis of major depression.

The severity is determined by the severity of depression and physical, social, and work maladjustment, as well as the duration of symptoms. Clinicians should ask patients gently but directly about any thoughts or plans to harm themselves or others, previous intentions and/or attempts to commit suicide, and other risk factors. The presence of psychosis and catatonia indicates severe depression. Melancholic symptoms indicate severe or moderate depression. Concomitant somatic disorders, alcohol and drug abuse, and anxiety disorders may aggravate the patient's condition.

Depressive disorders should be distinguished from demoralization and grief. Other mental disorders (such as anxiety disorders) may make it difficult to diagnose depression. Often a patient has more than one disorder. Major depression (unipolar disorder) must be distinguished from bipolar disorder.

In older patients, depression can manifest into depressive dementia (formerly known as pseudodementia), which causes many symptoms and signs of dementia, such as psychomotor retardation and decreased concentration. However, in the early stages, dementia can lead to depression. In general, when the diagnosis is not entirely clear, treatment for depressive disorder should be initiated.

Differentiating chronic depressive disorders (such as dysthymia) from substance abuse disorders is sometimes difficult, especially because these disorders can coexist and be mutually reinforcing.

Somatic disorders must also be excluded as a cause of depressive symptoms. Hypothyroidism often causes symptoms of depression and is quite common, especially among the elderly. In particular, Parkinson's disease may present with symptoms that resemble depression (eg, loss of energy, emotional scarcity, sluggish gesticulation). To exclude this disease, a thorough neurological examination is necessary.

Survey

There are no pathognomonic laboratory signs for depressive disorders. However, laboratory tests are necessary to rule out medical disorders that may cause depression. The test plan includes CBC, TSH level, electrolyte balance, vitamin B12, folate. In some cases, tests are carried out for prohibited substances.

Treatment of atypical disorders

The main treatment for all types of depression is the prescription of antidepressants. Depending on the method of influence, they are divided into:

1. Monoamine oxidase inhibitors (Phenalzine, Nialamid).
2. Selective serotonin reuptake inhibitors (Fluoxetine, Fluvoxamine, Sertraline, Citalopram, Paroxetine).

As a rule, other types of antidepressants are ineffective (Amitriptyline, Clomipramine, etc.).

Dietary therapy is prescribed to avoid reactions to antidepressants due to their incompatibility with certain foods. During treatment, cheeses, smoked products, coffee and chocolate, yeast products, beer and red wine are excluded from the diet. The combined use of medications with the above-mentioned products can lead to the development of angina pectoris, increased intracranial and blood pressure.

Atypical depression - a type of depression that is very difficult to treat - has symptoms such as weight changes, increased sleepiness and anxiety. Next, you will read about the causes of atypical depression and how to diagnose it, which will help you better tell your doctor about your condition.

What is atypical depression?

This is a subtype of depression that has its own special characteristics. In classic depression, the patient exhibits five or more of the following symptoms:

• Sadness
• Loss of vital energy
• Feeling hopeless
• Inability to enjoy your favorite activities
• Difficulty concentrating
• Uncontrollable tearfulness
• It's hard to make a decision
• Irritability
• Increased need for sleep
• Insomnia or excessive sleepiness
• Unreasonable pain
• Toothaches and indigestion
• Decreased sex drive
• Sexual dysfunction
• Headache
• Changes in appetite, leading to weight gain or loss
• Thoughts about death or suicide
• Attempts to commit suicide

Atypical depression has far fewer symptoms than classic depression. In addition, atypical depression manifests itself in those patients who suffered an attack of the classical form at an earlier age.

Despite its name, atypical depression is widespread. Some doctors believe that in most cases it remains undiagnosed. The ongoing studies are aimed at finding out whether atypical depression is a subtype of dysthymia, a milder form of depression that lasts for at least two years. The possibility that atypical depression is a milder form of bipolar disorder, called manic depression, is also being explored. Patients with manic-depressive psychosis experience less severe mood swings.

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What are the symptoms of atypical depression?

The main distinguishing feature of atypical depression from its acute form is the immediate reaction of mood to the situation. In other words, the patient feels better immediately after a positive life event. In acute depression or melancholia, such improvement will not occur. In addition to the immediate mood reaction, the diagnosis also takes into account the presence of at least two of the following symptoms:

• Oversleeping (excessive sleepiness)
• Overeating leading to weight gain
• Increased sensitivity to rejection, which affects the ability to function fully in society and at work
• Feeling of weight, paralysis and “leadenness” (heaviness in the limbs)

First of all, the doctor will examine whether there are physical causes for these symptoms. For example, taking tests to detect decreased thyroid function or hormone levels. Atypical depression can coexist with other diseases. For example, with hypothyroidism – low levels of hormones produced by the thyroid gland, which manifests itself in a depressed mood and weight gain. Doctors also identified the manifestation of atypical depression in growth hormone deficiency syndrome.

What are the causes of atypical depression?

Depression is thought to result from a chemical imbalance in the brain. These chemicals - such as neurotransmitters that enable communication between brain cells - include serotonin, dopamine and norepinephrine. Although the causes of depression are not clearly understood, risk factors for depression include:

• Genetic factor
• Significant loss in life - due to death, separation or divorce - that causes feelings of grief
• Interpersonal conflicts and, as a result, feelings of guilt
• Violence – physical, sexual or emotional
• An important life event, such as moving, changing or losing a job, graduating from school or university, retiring
• Serious illness such as cancer, heart disease, stroke or HIV
• Alcohol or drug abuse
• Self-isolation or expulsion from family or other social groups

What treatment options are there?

For atypical depression, the doctor will most likely prescribe antidepressants. One of the factors that distinguishes atypical depression into an individual disease is the fact that treatment with antidepressants such as Monoamine Oxidase Inhibitors and Selective Serotonin Reuptake Inhibitors gives a rapid effect. Unlike classic depression, atypical depression is not treatable with older types of antidepressants, such as tricyclic antidepressants.

Despite the fact that antidepressants based on monoamine oxidase inhibitors are most effective in treating atypical depression, doctors are in no hurry to prescribe them. This is due to the fact that the side effect of these drugs is the adverse effect of this medicine with the food consumed. People taking these drugs must follow a special diet. In addition to the usual precautions, such as limiting the intake of carbohydrates and fats, patients should also limit themselves to eating foods rich in tyramines. Tyramine inhibits the action of monoamine oxidase, an amino acid that neutralizes the effects of tyramine in the body. Below is a list of drinks and foods that contain tyramine:

• Aged cheeses – cottage cheese and cream cheese are considered safe
• Smoked meats, such as sausages such as pepperoni, salami, mortadella, as well as basturma and raw smoked meats
• Any products, storage rules that have been violated or products that have been in the refrigerator for more than two weeks
• Any combination of different foods - such as pizza - which may include foods rich in tyramine
• Sauerkraut
• Draft beer
• Fermented soy products, including soy sauces, teriyaki sauce, tempeh drink, bean spread and miso soup
• Yeast extracts and brewer's yeast (regular baker's yeast is safe)
• Broad beans and broad bean pods
• Banana peel

Alcohol consumption should also be limited - 100 grams of wine, 340 grams of bottled or canned beer and 28 grams of liquor - or eliminated.

In addition, these antidepressants interact with over-the-counter medications. These include:

• Products for weight loss and weight control
• Cold and antipyretic remedies
• Sprays and nasal drops
• Asthma inhalers or tablets
• Cough medicines
• Natural doping, such as ephedra and ginseng

It will also be advisable to reduce the dose of caffeine consumed.

Antidepressants of this type require abstinence from the above-mentioned substances and products during their use and for three to four weeks after stopping use. High levels of tyramine can cause dangerous reactions in the body, such as:

• Confusion
• Headache
• Heart diseases
• Increased blood pressure (hypertension)
• Nausea and vomiting
• Restlessness
• Visual impairment

Antidepressants of this type include the following drugs: selegeline, isocarboxazid (Marplan), phenelzine (Nardil) and tranylcypromine (Parnate).

Are there alternative treatments for atypical depression?

People suffering from atypical depression, as well as hypothyroidism or growth hormone deficiency know that treatment with hormones gives a positive result. In addition, a combination of antidepressants and anxiety medications, such as benzodiazepines, may be prescribed to treat general and anxiety-related depression. Benzodiazepine must be taken with caution as it has a high risk of addiction.

Due to restrictions regarding the use of antidepressants such as Monoamine Oxidase Inhibitors, very often doctors use antidepressants such as Selective Serotonin Reuptake Inhibitors. The purpose of these drugs is to increase serotonin levels in the brain. A newer drug acts on both sirotonia and norepinephrine. These drugs include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Escitalopram (Lexapro)
• Fluvoxamine (Luvox)
• Citalopram (Celexa)

Patients who are prescribed antidepressants such as monoamine oxidase inhibitors after taking antidepressants such as Selective Serotonin Reuptake Inhibitors should wait five weeks before starting this medication. This is due to the interaction between the side effects of both drugs. Side effects of serotonin antidepressants include:

• Withdrawal syndrome
• Increased sensitivity to sunlight
• Reduced blood sugar levels
• Rash
• Drowsiness and lethargy
• Impaired kidney and liver function

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Traditional medicine and prevention

Medicinal herbs are mainly used as sedatives or activity stimulants. Decoctions and infusions of motherwort, valerian, peony, oregano, heather, passionflower, hawthorn, teas with the addition of linden and mint have a sedative effect to normalize anxiety.

In case of loss of strength, exhaustion and fatigue, extracts and herbal teas from pink radiola, chamomile, mordovnik, tincture of lemongrass and ginseng are prescribed to increase vitality. Modern pharmaceuticals also use the medicinal properties of herbs to create medicines from plants: Novo-Passit, Deprim, which improve sleep, relieve anxiety and fatigue.

In order to avoid the development of depressive disorders, the following preventive measures will be useful:

1. Maintaining a healthy and active lifestyle: playing sports, walking, giving up bad habits.
2. Avoiding conflict situations and excessive physical and emotional stress.
3. Chat with friends.
4. Doing your leisure time with your favorite activities.
5. If possible, an annual vacation with a trip to nature.

Treatment of depressive conditions requires an individual approach to each patient from a psychotherapist or psychiatrist. This is a long and difficult process that combines competent therapy with the use of a complex of medications.

Symptoms and signs

Because this type of depression has special properties , it is difficult to recognize immediately. But there are certain external manifestations, in the presence of which you should consult a doctor.

Here are some of them:

• mood swings;
• sadness, depression, frequent desire to cry;
• work or other favorite activities do not bring joy;
• problems with attention;
• irritability;
• it is difficult to control your actions;
• excess sleep at night and high sleepiness during the day;
• increased appetite;
• thoughts of suicide.

Not all criteria must be present, since the disease is very individual.

Timely diagnosis and treatment are very important, because without help, a person with depression can not only ruin their life, but also lead to suicide .

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