Symptoms

Depression of any kind can cause:

• Feelings of sadness, emptiness or feeling tearful
• Loss of interest or pleasure in normal activities

In addition to standard symptoms of depression, atypical depression symptoms also include:

• Increased appetite
• Unintentional weight gain
• Increased desire to sleep
• Heavy, leaden feeling in the arms and legs
• Sensitivity to rejection or criticism that interferes with your social life or job
• Relationship conflicts
• Trouble maintaining long-lasting relationships
• Fear of rejection that leads to avoiding relationships
• Having depression that temporarily lifts with good news or positive events but returns later

When to see a doctor If you feel depressed, make an appointment to see your doctor as soon as you can. Depression may get worse if it isn't treated. Untreated depression can lead to other mental and physical health problems or problems in other areas of your life. Feelings of depression can also lead to suicide.

If you're reluctant to seek treatment, talk to a friend or loved one, a health care professional, a faith leader, or someone else you trust.

If you have suicidal thoughts If you or someone you know is having suicidal thoughts, get help right away. Here are some steps you can take:

• Contact a family member or friend.
• Seek help from your doctor, a mental health provider or another health care professional.
• Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor.
• Contact a minister, a spiritual leader or someone in your faith community.

When to get emergency help If you think you may hurt yourself or attempt suicide, call 911 or your local emergency number immediately. If you have a loved one who has harmed himself or herself, or is seriously considering doing so, make sure someone stays with that person. Take him or her to the hospital or call for emergency help.

Causes

It's not known exactly what causes atypical depression. As with other types of depression, a combination of factors may be involved. These include:

• Brain chemistry. Neurotransmitters are naturally occurring brain chemicals that are thought to play a direct role in depression. When these chemicals are out of balance, it may lead to depression symptoms.
• Inherited traits. Depression is more common in people whose biological family members also have the condition.
• Life events. Events such as the death or loss of a loved one, financial problems and high stress can trigger depression in some people.
• Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause permanent changes in the brain that make you more susceptible to depression.

Risk factors

Although the precise cause of atypical depression isn't known, certain factors seem to increase the risk of developing or triggering it, including:

• Having biological relatives with depression
• Being a woman — depression, especially atypical depression, is more common in women than in men
• Having depression that started when you were a teen or child
• Having traumatic experiences as a child
• Having biological relatives with a history of alcoholism
• Having family members who committed suicide
• Experiencing stressful life events, such as the death of a loved one
• Having few friends or other personal relationships
• Having depression after giving birth (postpartum depression)
• Having a serious illness, such as cancer, heart disease, Alzheimer's disease or HIV/AIDS
• Having certain personality traits, such as low self-esteem and being overly dependent, self-critical or pessimistic
• Abusing alcohol, nicotine or illegal drugs
• Having financial problems
• Taking certain medications, which include some high blood pressure medications, sleeping pills and certain other medications (talk to your doctor before stopping any medication you think could be affecting your mood)

Complications

Like other types of depression, atypical depression is a serious illness that can cause major problems. Atypical depression can result in emotional, behavioral and health problems that affect every area of your life. Complications associated with atypical depression can include:

• Substance abuse — many people with depression drink too much or abuse illegal drugs
• Anxiety, which may be connected to a fear of criticism or rejection
• Family conflicts
• Relationship difficulties
• Heart disease and other medical conditions
• Work or school problems
• Social isolation
• Suicidal feelings or suicide

Appointment

You're likely to start by seeing your primary care doctor. However, when you call to set up an appointment, you may be referred directly to a medical doctor who specializes in diagnosing and treating mental health conditions (psychiatrist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do These steps can help you make the most of your appointment:

• Write down any symptoms you've had, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins and supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions ahead of time will help you make the most of your appointment. List your questions from most important to least important in case time runs out. For problems related to depression, some basic questions to ask your doctor include:

• Is depression the most likely cause of my symptoms?
• Other than the most likely cause, what are other possible causes for my symptoms or condition?
• What kinds of tests will I need?
• What treatment is likely to work best for me?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there any restrictions that I need to follow?
• Should I see a psychiatrist or other mental health provider?
• Are there any possible side effects or other issues I should be aware of with the medications you're recommending?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time during your appointment.

What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you or your loved ones first notice your symptoms of depression?
• How long have you felt depressed? Do you generally always feel down, or does your mood fluctuate?
• How severe are your symptoms? Do they interfere with your daily life or relationships?
• Does your mood ever swing from feeling down to feeling euphoric and full of energy?
• How do you react to good news or positive events?
• How do you react to criticism or rejection?
• Do you constantly feel hungry or regularly overeat?
• How much do you sleep every day?
• Do you often feel fatigued or irritable?
• Do you ever have suicidal thoughts?
• Do you have any biological relatives with depression or another mood disorder? What treatment has helped them?
• What other mental or physical health conditions do you have?
• Do you drink alcohol or use illegal drugs?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?

Tests and diagnosis

When doctors suspect someone has depression, they generally ask a number of questions and may do medical and psychological tests. These tests can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests may include:

• Physical exam. This generally involves measuring your height and weight; checking your vital signs, such as heart rate, blood pressure and temperature; and listening to your heart and lungs.
• Laboratory tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.
• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms and whether you've had similar episodes in the past. You'll also discuss any thoughts you may have of suicide or self-harm. Your doctor may have you fill out a written questionnaire to help answer these questions.

Diagnostic criteria for atypical depression To be diagnosed with atypical depression, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of atypical depression, you must first meet the general DSM criteria for major depression — which includes feeling down and losing interest in things you once enjoyed. You'll also need to meet other, specific criteria for atypical depression.

For a diagnosis of atypical depression you must have this symptom:

• Being cheered up by positive events

In addition, you must have at least two of these symptoms for diagnosis:

• Gaining weight gain or having a noticeable increase in appetite
• Sleeping excessively
• Being sensitive to rejection by others
• Having a heavy feeling in the arms and legs

Atypical depression has a very specific definition as a diagnosable condition. But, be aware that some doctors and mental health providers may use the term more loosely. Ask for clarification if it isn't clear what exactly your doctor or mental health provider means when he or she says "atypical depression."

Treatments and drugs

Treatment for atypical depression is generally the same as treatment for other types of depression. Medications and psychological counseling (psychotherapy) are effective for most people.

In some cases, a primary care doctor can prescribe medications to relieve depression symptoms. However, many people need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist). Most people with atypical depression also benefit from seeing a psychologist or other mental health counselor. Usually the most effective treatment for depression is a combination of medication and psychotherapy.

Atypical depression most often occurs along with mild, long-lasting depression. However, it can cause more severe symptoms in some people, such as feeling suicidal or not being able to do basic day-to-day activities. If you have severe depression, a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making. You may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.

Here's a closer look at your treatment options.

Medications A number of medications are available to treat depression. They include:

• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). The most common side effects include decreased sexual desire and delayed orgasm. Other side effects may go away as your body adjusts to the medication. They can include digestive problems, jitteriness, restlessness, headache and insomnia.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. People with liver disease shouldn't take duloxetine.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. It's one of the few antidepressants that don't cause sexual side effects. At high doses, bupropion may increase your risk of having seizures.
• Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone (Desyrel) and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to other antidepressants to help with sleep.
• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. But because they tend to have more numerous and more severe side effects, a tricyclic antidepressant generally isn't prescribed unless you've tried an SSRI first without an improvement in your depression. Tricyclic antidepressants include amitriptyline, doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor) and others. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Older adults taking these medications are susceptible to memory problems, confusion and hallucinations. Tricyclic antidepressants are also known to cause weight gain.
• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as isocarboxazid (Marplan) and phenelzine (Nardil) — are usually prescribed only after other medications have been tried. That's because MAOIs can have serious side effects. These antidepressants require a strict diet because of dangerous (or even deadly) interactions with foods such as certain cheeses, pickles and wines and with some medications including decongestants. Selegiline (Emsam) is an MAOI that you stick on your skin as a patch rather than swallowing. It may cause fewer side effects than other MAOIs. Side effects aside, these medications are the antidepressants most proven to treat atypical depression. They may be effective when other medications, such as tricyclic antidepressants, don't work.
• Other medications. Your doctor may suggest other medications to treat your depression. These may include stimulants, mood-stabilizing medications, anti-anxiety medications or antipsychotic medications. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. This strategy is known as augmentation.

Finding the right medication Everyone's different, so finding the right medication or medications for you will likely take some work. If a family member has responded well to an antidepressant, it may be one that could help you. You may need to try several medications before you find one that works. This can require patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as your body adjusts. If you have bothersome side effects, don't stop taking an antidepressant without talking to your doctor first.

Some antidepressants can cause withdrawal symptoms unless you slowly taper off your dose, and quitting suddenly may cause a sudden worsening of depression. Don't give up until you find an antidepressant or medication that's suitable for you — you're likely to find one that works and has tolerable side effects.

If antidepressant treatment doesn't seem to be working, your doctor may recommend a DNA test to check for specific genes that affect how your body uses antidepressants. Cytochrome P450 genotyping tests may be able to help predict how well your body will processes (metabolize) a medication. This may help guide your doctor in identifying an antidepressant that's likely to work for you and cause the fewest side effects. Genetic tests are new, so they aren't widely used yet. It isn't clear how well they work to predict which antidepressant is likely to work best.

Antidepressants and pregnancy If you're pregnant or breast-feeding, some antidepressants may pose an increased health risk to your unborn child or nursing child. Talk to your doctor if you become pregnant or are planning on becoming pregnant.

Antidepressants and increased suicide risk Although most antidepressants are generally safe, be careful when taking them. The Food and Drug Administration (FDA) warns that children, adolescents and young adults ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Psychotherapy Psychological counseling is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about your condition and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy.

Psychotherapy sessions can help you:

• Learn about the causes of depression so that you can better understand how to cope with it
• Learn how to identify and make changes in unhealthy behavior or thoughts
• Explore relationships and experiences that could be linked to feelings of depression
• Find better ways to cope with stressful situations and solve problems
• Set realistic goals
• Regain a sense of happiness and control in your life
• Improve depression symptoms such as hopelessness and anger
• Help you cope with a crisis or other current difficulty

There are several types of psychotherapy that are effective for depression. Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other people or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy, psychodynamic psychotherapy, and acceptance and commitment therapy (ACT) are other types of counseling commonly used to treat atypical depression and other types of depression.

Hospitalization and residential treatment programs In some people, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Getting psychiatric treatment at a hospital can help keep you calm and safe until your mood improves. Partial hospitalization or day treatment programs also are helpful for some people. These outpatient programs provide the support and counseling you need while you get symptoms under control.

Home remedies

Depression generally isn't an illness that you can treat on your own. But you can do some things for yourself that will help. In addition to professional treatment, follow these self-care steps:

• Stick to your treatment plan. Don't skip psychotherapy sessions or appointments, even if you don't feel like going. Even if you're feeling well, resist any temptation to skip your medications. If you stop, depression symptoms may come back, and you could also experience withdrawal-like symptoms.
• Learn about depression. Education about your condition can empower you and motivate you to stick to your treatment plan.
• Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your depression symptoms. Make a plan so that you know what to do if your symptoms get worse. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Ask family members or friends to help watch for warning signs.
• Get exercise. Physical activity reduces depression symptoms. Consider walking, jogging, swimming, gardening or taking up another activity you enjoy.
• Avoid alcohol and street drugs. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.

Alternative medicine

You may be interested in trying to relieve depression symptoms with complementary or alternative medicine strategies. These include supplements and mind-body techniques. Make certain you understand risks as well as possible benefits before pursuing alternative therapy. Don't replace conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for professional care.

Here are some common alternative treatments that are used for depression.

Herbal remedies and supplements A number of herbal remedies and supplements have been used for depression. A few common ones include:

• St. John's wort. Known scientifically as Hypericum perforatum, this is an herb that's been used for centuries to treat a variety of ills, including depression. It's not approved by the Food and Drug Administration to treat depression in the United States. Rather, it's classified as a dietary supplement. However, it's a popular depression treatment in Europe.
• SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. It's not approved by the FDA to treat depression in the United States. Like St. John's wort, it's classified as a dietary supplement. However, it's used in Europe as a prescription drug to treat depression.
• Omega-3 fatty acids. Eating a diet rich in omega-3s or taking omega-3 supplements may help ease depression and also appears to have a number of other health benefits. These healthy fats are found in cold-water fish, flaxseed, flax oil, walnuts and some other foods. It isn't clear yet whether omega-3s from vegetable sources work as well as fish oil.

Some herbal and dietary supplements for depression — particularly St. John's wort — can interfere with prescription medications or cause dangerous interactions. To be safe, talk to your doctors and other health care providers before taking any supplements.

Mind-body connections The connection between mind and body has been studied for centuries. Complementary and alternative medicine practitioners believe the mind and body must be in harmony for you to stay healthy.

Mind-body techniques that may be helpful for depression include:

• Acupuncture
• Yoga
• Meditation
• Guided imagery
• Massage therapy

As with dietary supplements, take care in using these techniques. Although they may pose less of a risk, relying solely on these therapies is generally not enough to treat depression. If you try mind-body techniques or other alternative therapies first to treat your depression but your symptoms worsen or don't improve, talk to your doctor.

Coping and supprt

Coping with depression can be challenging. Talk to your doctor or therapist about improving your coping skills, and try these tips:

• Simplify your life. Cut back on obligations when possible, and set reasonable goals for yourself. Give yourself permission to do less when you feel down.
• Consider writing in a journal. Journaling can improve mood by allowing you to express pain, anger, fear or other emotions.
• Read reputable self-help books. Your doctor or therapist may be able to recommend books to read.
• Locate helpful organizations. A number of organizations offer support groups, counseling and other resources can that can help with depression. For example, the National Alliance on Mental Illness offers free online and in-person education, discussion groups and classes for people with depression and their family members. Many employee assistance programs and religious organizations also offer help for mental health concerns.
• Don't become isolated. Try to participate in social activities, and get together with family or friends regularly.
• Take care of yourself. Eat a healthy diet, exercise regularly and get plenty of sleep.
• Learn ways to relax and manage your stress. Examples include meditation, yoga and tai chi.
• Structure your time. Plan your day and activities. You may find it helpful to make a list of daily tasks, use sticky notes as reminders or use a planner to stay organized.
• Don't make important decisions when you're down. Avoid decision making when you're feeling very depressed, since you may not be thinking clearly.

Prevention

There's no sure way to prevent depression. However, taking steps to control stress, to increase your resilience and to boost your self-esteem may help. Friendship and social support, especially in times of crisis, can help you weather rough spells. In addition, treatment at the earliest sign of a problem can help prevent depression from worsening. Long-term maintenance treatment also may help prevent a relapse of symptoms.