Atypical Depression: The Type of Depression Where Your Mood Can Still Brighten — and How It's Treated
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD. Last reviewed October 13, 2026. This content is for educational purposes and is not medical advice.
Quick Answer
Atypical depression is a specific type of depression, officially major depression with atypical features, in which mood can temporarily brighten after positive events [1] [5]. Signature symptoms include increased appetite, oversleeping, heavy limbs and extreme sensitivity to rejection [1] [5]. It affects women twice as often as men and usually begins in the teens or early 20s [1]. Treatment is usually psychotherapy and/or antidepressants [1].
What the research says
Atypical depression is common among people with depression, and treatment guidance is still limited. A review of the literature reported that epidemiological studies using DSM criteria suggest 15% to 29% of depressed patients have atypical depression, while clinical studies point to 18% to 36%. The authors noted that, despite numerous drug trials, there are no comprehensive treatment guidelines for it, and the older idea that it responds mainly to MAOIs is of limited use today (Łojko & Rybakowski, Neuropsychiatric Disease and Treatment, 2017) [5].
Atypical depression is the subtype most consistently linked to obesity and diabetes risk. In a systematic review of 45 articles, 14 of the studies comparing depression subtypes for obesity risk favored atypical depression as carrying the greatest risk (8 showed similar or null associations). For diabetes risk, 7 studies favored atypical depression, 3 favored other subtypes, and 5 showed similar or null associations (Shell et al., Journal of Affective Disorders, 2024) [6].
CBT delivered online works about as well as in-person CBT. A meta-analysis of 31 randomized trials in adults, half of them in depression or anxiety, found that therapist-supported internet-based CBT and face-to-face CBT had equivalent effects (pooled effect size g = 0.02; 95% CI −0.09 to 0.14). The review covered 16 conditions and was not specific to atypical depression (Hedman-Lagerlöf et al., World Psychiatry, 2023) [7].
What Is Atypical Depression?
Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms stray from the traditional criteria [1].
One symptom is specific to atypical depression: a temporary mood improvement in response to actual or potential positive events. This is known as mood reactivity [1] [5]. Other key symptoms include increased appetite and rejection sensitivity [1].
“Atypical” doesn’t mean the condition is odd or unusual. It’s just different from “typical” depression [1].
What Is the Difference Between Typical and Atypical Depression?
Typical and atypical depression are both mental health conditions that involve prolonged feelings of sadness and hopelessness [1]. The main difference is that in atypical depression, your mood can temporarily brighten as a result of positive events (such as a fun birthday party). In typical major depression, your depressed mood is usually constant [1].
Feature | Typical Depression | Atypical Depression |
Mood during positive events | Usually stays constant and low | Can temporarily brighten (mood reactivity) |
Appetite | Often decreases (loss of appetite) | Usually increases, sometimes with significant weight gain |
Sleep | Often insomnia (trouble falling or staying asleep) | Oversleeping or feeling sleepy despite sleeping enough |
When it begins | Varies | Tends to begin earlier, in teen years or early 20s |
How long it lasts | Varies | Tends to last longer, often becoming chronic |
Who Gets Atypical Depression?
Atypical depression is twice as likely to affect women than men [1]. It tends to begin in the teen years or early 20s [1].
How Common Is Atypical Depression?
Despite its name, atypical depression is quite common. It affects 15% to 36% of people with a depressive disorder [1] [5]. Approximately 121 million people worldwide have a depressive disorder [1].
What Are the Symptoms of Atypical Depression?
The main sign of atypical depression (in comparison to typical depression) is that your mood temporarily improves in response to positive events [1]. This usually doesn’t happen in typical depression.
In addition, people with atypical depression have at least two of the following symptoms [1]:
Symptom | What It Looks Like |
Increased appetite and/or significant weight gain | Eating more than usual, putting on notable weight |
Hypersomnia | Excessive sleepiness; sleeping too much |
Leaden paralysis | A heavy feeling in the arms or legs |
Rejection sensitivity | Increased sensitivity to criticism or rejection that causes significant social and occupational impairment; reactions may follow imagined, anticipated, or real rejection |
Other depressive symptoms that apply to atypical depression include feeling very sad or hopeless, not enjoying things that used to bring joy, being easily irritated or frustrated, and having a difficult time concentrating or remembering things [1].
What Causes Atypical Depression?
Researchers don’t know exactly why some people experience depression or atypical depression. But they believe the following factors contribute to its development [1]:
Impaired functioning of neurotransmitters (chemicals that carry brain signals to other parts of your body) and/or neuroreceptors (the “receivers” of the signals) [1].
Genetics. Having a biological family member with mood disorders, including bipolar disorder and persistent depressive disorder (PDD), may contribute [1].
Trauma [1].
Chronic stress [1].
What Increases the Risk?
Risk Factor | Examples |
Mental health history | History of bipolar disorder and/or anxiety |
Childhood experiences | Negative childhood experiences (adverse childhood experiences); emotional, physical, or sexual abuse |
Health events | Significant illness, such as a major injury or a chronic illness |
Life losses | Grief following a significant loss |
Substance history | History of substance use |
How Is Atypical Depression Diagnosed?
Healthcare providers diagnose atypical depression based on a thorough understanding of your symptoms and medical and mental health history [1].
A provider will likely perform a physical exam and may order certain blood tests to rule out physical causes of depressive symptoms, such as thyroid disease [1] [3].
The provider may refer you to a mental health specialist (a psychologist or psychiatrist) for diagnosis and treatment [1].
How Is Atypical Depression Treated?
Atypical depression often responds well to treatment [1]. Your treatment may vary depending on the condition’s severity. Treatments usually include psychotherapy (talk therapy) and/or medication [1].
Lifestyle changes, such as exercising regularly or quitting alcohol or recreational drug use, can also help improve symptoms [1] [2].
Psychotherapy (Talk Therapy)
“Psychotherapy” is a term for a variety of treatment techniques that aim to help a person identify and change unhealthy emotions, thoughts and behaviors.
Psychotherapy takes place with a trained, licensed mental health professional, such as a psychologist or psychiatrist. It can provide support, education and guidance to help you function better and increase your well-being.
Mental health professionals often use cognitive behavioral therapy (CBT), one type of psychotherapy, to help treat atypical depression [1]. During CBT, your therapist or psychologist helps you take a close look at your thoughts and emotions. You’ll come to understand how your thoughts affect your actions. Through CBT, you can unlearn negative thoughts and behaviors and learn to adopt healthier thinking patterns and habits [1] [2].
Antidepressant Medications
Various medications are available to treat depression (antidepressants), including atypical depression. There’s no single best antidepressant [1] [4], and the best one for you depends on your symptoms and individual needs.
Usually, antidepressants help balance your levels of neurotransmitters, including serotonin, dopamine and norepinephrine [1].
Antidepressant Class | Full Name |
SSRIs | Selective serotonin reuptake inhibitors |
SNRIs | Serotonin and noradrenaline reuptake inhibitors |
TCAs | Tricyclic antidepressants |
MAOIs | Monoamine oxidase inhibitors |
NDRIs | Norepinephrine and dopamine reuptake inhibitors |
NMDA receptor antagonists | Noncompetitive N-methyl-D-aspartate receptor antagonists |
Historically, people with atypical depression have responded best to MAOIs [1] [5]. However, this class has more severe side effects than other classes, plus significant dietary restrictions [1]. Because of this, healthcare providers don’t prescribe MAOIs as often [1].
Your provider will work with you to find the best medication for you.
What’s the Outlook?
The prognosis (outlook) for atypical depression depends on whether it’s properly treated [1].
Atypical depression is a serious medical condition with potential complications if it isn’t treated, including binge eating and weight gain due to increased appetite, increased risk of suicide, worsening of co-occurring medical conditions, increased conflict in relationships, increased risk of substance use, and increased missed time and loss of effort at work or school [1].
Outlook Fact | What It Means |
With appropriate treatment | 70% to 80% of people with depression experience a significant improvement in symptoms |
First treatment may not work | As many as 50% of people may not respond to the initial treatment. Keep trying to find the right plan |
How Can I Prevent Atypical Depression?
You can’t always prevent atypical depression [1]. Steps you can take to reduce your risk include managing stress with healthy coping strategies, seeking medical help at the first sign of depression, and talking about your feelings with someone you trust [1].
When Should I See My Healthcare Provider?
If you have symptoms of atypical depression, see a healthcare provider. They can give you an accurate diagnosis, refer you to a specialist or suggest treatment options.
If you or a loved one are thinking about suicide, dial 988 on your phone to reach the Suicide and Crisis Lifeline [1]. Someone will be available to help you 24/7.
Like depression and other mental health conditions, seeking help as soon as symptoms appear can help decrease the disruptions to your life. Mental health professionals can offer treatment plans that can help you manage the condition.
Conclusion
Atypical depression gets its name because its symptoms stray from the traditional picture of depression: mood that can still brighten after good news, an appetite that grows instead of shrinks, sleep that overflows instead of evaporates, limbs that feel leaden, and a raw sensitivity to criticism or rejection. It strikes women about twice as often as men [1], usually begins in the teen years or early 20s, and affects 15% to 36% of people with a depressive disorder [1] [5], making it anything but rare.
The good news is that it often responds well to treatment. Psychotherapy (especially cognitive behavioral therapy), antidepressants, and lifestyle changes like regular exercise can all help, and 70% to 80% of people with depression experience significant improvement with appropriate treatment [1]. The first medication you try may not be the one that works. As many as half of people don’t respond to initial treatment [1], but the right plan is out there. If any of these symptoms describe you or someone you love, don’t wait: talk to a healthcare provider, and explore Rinnit.com’s library of mental health guides for clear answers on depression, anxiety, and beyond.
Frequently Asked Questions
What is atypical depression? Atypical depression (also called major depression with atypical features) is a specific type of depression in which the symptoms stray from the traditional criteria, with the defining feature being mood reactivity, a temporary mood improvement in response to positive events.
What does “mood reactivity” mean? It means your mood can temporarily brighten after actual or potential positive events, like a fun birthday party. This usually doesn’t happen in typical major depression, where the depressed mood is usually constant.
Does “atypical” mean it’s rare or strange? No. “Atypical” just means different from typical depression. The condition is actually quite common, affecting 15% to 36% of people with a depressive disorder.
What are the four signature symptoms of atypical depression? Increased appetite or significant weight gain, hypersomnia (excessive sleepiness), leaden paralysis (a heavy feeling in the arms or legs), and rejection sensitivity that causes significant social and occupational impairment.
What is leaden paralysis? A heavy feeling in the arms or legs. It’s one of the hallmark symptoms of atypical depression.
How is atypical depression different from typical depression? Besides mood reactivity, atypical depression usually increases appetite and sleep, while typical depression often causes loss of appetite and insomnia. Atypical depression also tends to begin earlier (teen years or early 20s) and last longer, often becoming chronic.
Who is most likely to get atypical depression? Women. It’s twice as likely to affect women than men, and it tends to begin in the teen years or early 20s.
What causes atypical depression? Researchers don’t know exactly why. Contributing factors include impaired functioning of neurotransmitters and neuroreceptors, genetics (a family member with mood disorders), trauma, and chronic stress.
What increases the risk of developing it? A history of bipolar disorder or anxiety, adverse childhood experiences, emotional/physical/sexual abuse, significant illness, grief following a major loss, and a history of substance use.
How is it diagnosed? Through a thorough understanding of your symptoms and medical/mental health history, usually with a physical exam and sometimes blood tests to rule out physical causes like thyroid disease. Your provider may refer you to a psychologist or psychiatrist.
Can atypical depression be treated? Yes, it often responds well. Treatment usually includes psychotherapy (talk therapy, often CBT) and/or medication, with lifestyle changes like regular exercise and quitting alcohol or recreational drug use helping too.
Which medications treat atypical depression? There are six antidepressant classes: SSRIs, SNRIs, TCAs, MAOIs, NDRIs, and NMDA receptor antagonists. They work by balancing neurotransmitters like serotonin, dopamine, and norepinephrine. Historically MAOIs worked best for atypical depression, but their severe side effects and dietary restrictions mean they’re prescribed less often today.
What happens if atypical depression isn’t treated? It can lead to binge eating and weight gain, increased risk of suicide, worsening of co-occurring medical conditions, more relationship conflict, higher substance use risk, and missed time at work or school.
What are the chances treatment works? With appropriate treatment, 70% to 80% of people with depression experience significant improvement, though up to 50% may not respond to the first treatment, so keep working with your provider to find the right plan.
What should I do if I’m thinking about suicide? Dial 988 on your phone to reach the Suicide and Crisis Lifeline. Someone will be available to help you 24/7.
References
Cleveland Clinic. Atypical Depression. Cleveland Clinic. Last updated February 15, 2023. https://my.clevelandclinic.org/health/diseases/21131-atypical-depression
American Psychiatric Association. What Is Depression? American Psychiatric Association. Reviewed April 2024. https://www.psychiatry.org/patients-families/depression/what-is-depression
Coryell W. Depression. Merck Manual Consumer Version. Last updated January 2026. https://www.merckmanuals.com/home/mental-health-disorders/mood-disorders/depression
National Institute of Mental Health. Mental Health Medications. National Institute of Mental Health. Last reviewed December 2023. https://www.nimh.nih.gov/health/topics/mental-health-medications
Łojko D, et al. Atypical depression: current perspectives. Neuropsychiatr Dis Treat. 2017;13:2447-2456. PMID 29033570. https://doi.org/10.2147/NDT.S147317
Shell AL, et al. Depressive disorder subtypes, depressive symptom clusters, and risk of obesity and diabetes: A systematic review. J Affect Disord. 2024;353:70-89. PMID 38432462. https://doi.org/10.1016/j.jad.2024.02.051
Hedman-Lagerlöf E, et al. Therapist-supported Internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. World Psychiatry. 2023;22(2):305-314. PMID 37159350. https://doi.org/10.1002/wps.21088
Medical Disclaimer
This article is for general informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read here. If you or someone you know is thinking about suicide, dial 988 to reach the Suicide and Crisis Lifeline (available 24/7).
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