I have bipolar I disorder. My depression is labeled "atypical". What does that mean? Does that require different treatment?

“Atypical depression” is a term sometimes used to describe depression with a specific pattern of symptom, including:

  • Sleeping more than normal (rather than sleeping less)
  • Increased appetite or over-eating (rather than decreased appetite)
  • Feelings of physical “heaviness”
  • Mood that is more sensitive to upsetting or stressful situations (especially feelings of rejection)

Even though this pattern is called “atypical”, it is not uncommon. And it may actually be the more typical pattern of depression in people who live with bipolar disorder (rather than just unipolar depression).

Research in the 1980s and 1990s found that people with atypical depression (compared to people with “typical” depression) were more likely to benefit from monoamine oxidase inhibitor or MAOI antidepressants (like phenelzine or Nardil) than from tricyclic antidepressants (like imipramine or Tofranil). These days, neither of those types of medication is used very often for treatment of depression. Some more recent research has examined whether that atypical depression pattern predicts better or worse results with various newer types of antidepressants. So far, that research has not found that an atypical symptom pattern is helpful when choosing one of the newer medications.

While MAOI antidepressants may be more effective for atypical depression, they can have dangerous interactions with other medications and even with some types of food. For that reason, most doctors do not think of MAOI antidepressants as a first choice for people with atypical depression. But it is reasonable to consider MAOI medications when more common (and safer) treatments have not worked.

About the Doc

About the Doc

Greg Simon, MD, MPH, is a psychiatrist and researcher at  Kaiser Permanente Washington Health Research Institute in Seattle. His research focuses on improving the quality and availability of mental health services for people living with mood disorders, and he has a specific interest in activating consumers to expect and demand more effective mental health care.

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