What is the difference between Melancholy and Atypical Depression?


By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Depressed person

Depression.
Photo courtesy of Pixabay.com

How are Melancholy depression, atypical depression, and major depressive disorder related?

When you read around on the internet, and in some books on the subject also, you will find a lot of different names for depression. Some of these are understood as separate disorders because in doing research or in the way these disorders affect clients they look like different but related conditions. Some of these terms are primarily descriptors, technically descriptors, for the most significant feature of the depression. Some of the terms you will read about elsewhere are more descriptions of the thing that may have caused or may be causing the depression.

Someday we may be able to run a precise test, brain scan, or blood test and identify specific forms of depression. There has been a lot of promising research in this field and some huge claims about the ability to diagnose mental disorders by this or that test, but as of now most diagnosing is done by asking the patient questions, counting up symptoms, and then if you have enough symptoms you get a disorder with a particular name.

Melancholy depression or atypical depression.

Melancholy depression and atypical depression are two “Specifiers” used to group cases of Major Depressive Disorder with similar features together for ease of reference. In the newer diagnostic book (DSM-5) there are 9 specifiers. These specifiers are somewhat changed from the older DSM-4 system. What follows is my oversimplified explanation, for the full text of the description you would need to look at the APA book DSM-5.

What is Melancholy Depression?

Almost total loss of pleasure. Stuff that used to make you happy now just does not interest you. If you are too depressed to think about sex or a hobby you used to love, chances are you have melancholic depression.

With Melancholic depression, nothing is likely to snap you out of it. You see a show that others say is funny but you can’t enjoy it and laughter is just too much work. If something good happens, it does not make you feel good even for a little while.

People with Melancholic depression have a noticeable down mood. They are despondent, hopeless, or in despair. People with this form of major depression wake up way early and their depression is worse in the morning. They have changes in appetite and feel guilty.

This is the kind of depression that made its way into novels in the last century and may still be seen on soap operas. These literary efforts make this look like it is someone being dramatic or overacting. In the clinic, this is a real enough disorder and people with this condition are not faking it for attention.

Depression with atypical features specifier.

With atypical features, the depressed person can snap out of it a little for a while if something really good happens. They laugh at a joke, some of the time. The trouble is that the happy feeling is fleeting and disappears before they realize they just smiled.

With atypical features, the person has significant weight gain and or increased appetite. They are always tired and drag around. With this type of major depression, the image that should come to mind is a bear hibernating for the winter. They eat everything in sight and then sleep for hours. Upon waking they are too tired to walk around and after eating they return to sleep.

People with atypical features to their depression customarily have had a long-term pattern of feeling rejected. They are very sensitive to any hint of rejection, judgment, or criticism and this often interferes with personal relationships, job, school, or any other activity that involves getting along with others.

With Seasonal pattern depression specifiers.

Another specifier would be added if this person had the depression only at one particular time of year or at a transition between seasons. This requires the change of weather or seasons to be the trigger for the depression. If you work a summer or winter job and get laid off each year that is not seasonal depression. We know what caused it and the weather need not get blamed.

This type of depression is often called winter blues or it used to be called seasonal affective disorder before we split bipolar and depression into two very different groups of disorders.

Peripartum onset specific for depression.

The name of this specifier was changed and I think for good reason. This is the “thing” that used to get called postpartum depression. Turns out that lots of times this started out in the middle of the pregnancy. Starting before the birth of the baby is a bad sign as often this results in a more severe depressive episode.

Women who had postpartum depression now called Major depressive disorder with Peripartum onset found that with each succeeding pregnancy the depression gets worse.

With psychotic features turns into two specifiers.

What used to be major depressive disorder with psychotic features has been subdivided into two specifiers. One is Mood congruent psychotic features and the other is mood-incongruent psychotic features.

Catatonia.

This is that condition where a person stands frozen like a statue. It can be diagnosed separately without any depression but occasionally it appears as a specific type or specific form of major depressive disorder.

This is a quick, abbreviated, run down on some features of Major Depressive Disorder. If you or anyone you know has these symptoms seek professional help. Getting help is not giving in to your illness. Getting help early can keep depression from getting far worse and ruining your relationships, job, or your happy life.

For more posts on depression:

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1 thought on “What is the difference between Melancholy and Atypical Depression?

  1. Pingback: Eight ways depression gets overlooked in adults. | counselorssoapbox

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