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definitions (for dj)

Posted by Elizabeth on November 9, 1999, at 7:39:34

In reply to Re: atypical depression vs typical -- Eliz?, posted by dj on November 8, 1999, at 2:10:19

Hi dj. This is from DSM-IV (paraphrased):

Atypical depression is characterized by "reactive mood" (i.e., can sometimes "cheer up" in response to pleasant experiences) and 2 or more of the following:
- increase in appetite (often with significant weight gain) (may manifest as cravings for sweets)
- hypersomnia
- "leaden paralysis:" feelings of heaviness, especially in arms and legs
- trait rejection sensitivity (not exclusively during depression, but may be worse when depressed)

Atypical depression may be associated with irritability or mood swings (the reactive mood works both ways); substance abuse; personality disorders (e.g., borderline, histrionic, avoidant) or anxiety disorders (e.g., panic disorder, social phobia). Atypical depression occurs 2-3 times as often in women as in men. Onset is often in adolescence or early adulthood. Course tends to be chronic, or episodic with only partial recovery between episodes. Seasonal affective disorder usually presents as atypical.

Melancholia, in contrast, requires that an individual's mood be "nonreactive" (i.e., inability to experience pleasure from previously enjoyable activities; does not cheer up even when something good happens) along with 3 or more of the following:
- depressed mood is experienced as being different from normal moods such as grief, loneliness, sadness, etc.
- depression is generally worst in the morning
- early morning awakening
- psychomotor retardation or agitation (i.e., appears slowed-down or sped-up)
- loss of appetite/significant weight loss
- excessive or inappropriate feelings of guilt or self-reproach

Melancholic features predict greater severity of depression, nonresponse to placebo, and response to ECT or antidepressants. Certain laboratory findings are more common in patients with melancholic depression than in those with nonmelancholic depression. Melancholic depression is equally common among men and women and more common in older people than in younger people.

A third cateogory that is sometimes used is "simple mood-reactive depression." This is just mood-reactive depression without atypical features. I think it's probably the most common kind, and also the least understood.




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