How is atypical depression diagnosed?

It’s diagnosed using standard criteria for major depressive disorder (MDD) or persistent depressive disorder (dysthymia), with the addition of specific atypical features.

It’s not a standalone diagnosis in the DSM-5 but a specifier (a way to add nuance to a diagnosis).

Here’s how the diagnosis typically works:

1. Diagnose a depressive episode first

A person must meet the criteria for either:

• • Major depressive episode (at least 5 of the 9 DSM-5 symptoms lasting at least 2 weeks, including either depressed mood or anhedonia).

• • Or persistent depressive disorder (chronic low mood for at least 2 years).

2. Check for atypical features (specifier criteria)

According to the DSM-5, atypical depression is defined by:

• • Essential feature: Mood reactivity

• • • Mood temporarily improves in response to positive events (e.g., good news, compliments).

• • Plus, at least two of the following:

• • • Increased appetite or significant weight gain.
      

• • • Hypersomnia (sleeping much more than usual).

• • • Leaden paralysis, a heavy, lead-like feeling in the arms or legs.

• • • Long-standing sensitivity to interpersonal rejection, not limited to depressive episodes, and serious enough to cause problems in relationships or work.

These symptoms must occur during the same depressive episode.

Clinical assessment tools that may be used

• Structured clinical interviews (like SCID-5 or MINI).

• Questionnaires such as:

• • Inventory of Depressive Symptomatology (IDS).

• • The Atypical Depression Diagnostic Scale (ADDS) is used more in research.

• Patient history is critical:

• • Sleep and eating habits.

• • Emotional reactivity.

• • Social patterns and past interpersonal issues.

Challenges in diagnosis

• Mood reactivity is subjective and may be hard for people to recognize in themselves.

• Atypical symptoms overlap with other conditions like bipolar spectrum disorders and anxiety.

• Gender bias: Women may be more frequently diagnosed, but some men may be underdiagnosed due to how symptoms present.

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