Atypical depression

• Clinical features:

  • Mood is depressed but remains reactive - able to enjoy certain experiences but not to normal levels
  • Hypersomnia - >10hrs/day, at least 3 days/week, for at least 3 months
  • Hyperphagia - weight gain of >3kg in 3 months
  • Leaden paralysis - feeling of heaviness in the limbs, present for at least 1hr/day, 3 days/week, for at least 3 months
  • Oversensitivity to perceived rejection
  • Other infrequent symptoms - initial insomnia, reversed diurnal mood variation (better in morning), severe motor retardation, absence of feelings of guilt
• Epidemiology:

  • Onset usually in late teens and early 20s
  • Often a family history of mood disorder
• Comorbidity:

  • Higher rates of following than other depressive disorders:
  • Anxiety - especially panic disorder and social phobia
  • Somatization disorder
  • Alcohol and drug misuse
• Management:

  • Best evidence for the use of Phenelzine or other MAOI
  • Alternatively an SSRI