Depression with a smile

Patients suffering from depression seem gloomy to us, always suffering and unable to enjoy life. However, a person with depression may seem quite normal and even happy to others. He may have a job, a family, a home — and no particular reason for longing and sadness. Such a person can maintain a pleasant conversation, smile and joke, lead an active social life – this form of depression was not for nothing called “smiling”, but officially – “atypical”. The biggest danger of her is that even the patient himself may not believe that he is sick – his illness is well-disguised, but still gradually destroys his psyche and personality, sometimes leading to tragic consequences, even suicide.

Atypical depression as a mental disorder

Psychiatrists started talking about atypical depression for the first time in 1959, and in 1994 this term officially entered clinical psychiatry.

In itself, the word “atypical” is usually associated with something rare, exceptional, unusual. But not in this case. Today, scientists and doctors recognize that atypical   depression   is the most common form of this disease among patients on outpatient treatment. Given that about one in ten people suffer from depression, the proportion of people with atypical form among patients with clinical depression or dysthymia varies, according to various sources, from 15 to 40%. Moreover, women are 4 times more likely to experience atypical depression compared with men.

An interesting point: atypical depression often manifests itself at an early age. Therefore, for example, the first depressive symptoms in adolescents or patients at the age of about 20 years usually manifest themselves in the form of atypical depression.

How is “depression with a smile” different from other forms of the disease?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), on atypical   depressed   speak in the presence of the following symptoms:

  • Mood reactivity (14.7% of cases), in response to positive events, mood improves dramatically.
  • Two or more symptoms that last at least two weeks:
  1. Increased appetite (32.4%) or weight gain (20.6%).
  2. Increased sleep duration ( hypersomnia , 20.6%).
  3. Lead paralysis (11.7%) – a feeling of “lead gravity” in the arms or legs.
  4. Hypersensitivity to reactions to their actions by others, which causes severe social or professional dysfunction.
  • Symptoms do not correspond to manifestations of melancholic or catatonic depression.

It should be said separately about the two symptoms of “smiling depression.” These are powerful mood swings for any positive changes in life. It is even about such trifles as received SMS with gratitude, praise at work or positive feedback in social networks. For a few minutes, such a person feels uplifted and in excellent health, before he returns to the deep feeling of despondency. And the second important point: such people are very vulnerable and sensitive to criticism or the reaction of their rejection.

How does the atypical depression differ from melancholic depression, a form of severe depressive disorder, based on the listed symptoms?

  • In people with atypical depression, their mood improves in response to life positives, and patients with melancholic depression do not “emerge to the surface” even if something good happens.
  • Atypical depression can lead to an improvement in appetite and even weight gain, and “depressive melancholic” usually, on the contrary, lose kilograms, even anorexia.
  • With atypical depression, a person tends to sleep during the day, while with melancholic depression, on the contrary, the amount of sleep decreases, early awakenings are characteristic.
  • The feeling of lead in the extremities with atypical depression does not occur in “melancholic”, they often develop psychomotor agitation or inhibition.
  • The feeling of guilt during mood swings is characteristic of melancholic depression, and atypical, painful sensitivity to the reactions of others is increased.
  • Exacerbations of depression in melancholic depression usually develop in the morning, and in case of atypical depression in the evening.

Doctors believe that atypical depression may be part of other diseases.   psyche such as bipolar disorder, unipolar depression or dysthymia. Depending on which of them prevails, the listed symptoms will be expressed more or less clearly.

The problem of diagnosing “smiling depression”

Psychiatrists emphasize that it is very important to correctly diagnose atypical depression, because this form of the disease differs from others not only in its manifestations, but also in its response to treatment.

Patients with atypical depression often feel guilty for their melancholy mood and their inability to calmly relate to life, like most other people. When talking with the doctor, they subsequently explain that they see no reason for sadness and are ashamed of manifestations of their “atypical” feelings.

Among the diagnostic errors, the doctors themselves indicate, in particular, that lead paralysis can be mistaken for manifestations of chronic fatigue. A common symptom can cause a misdiagnosis of a neurosis. As a result, antidepressants can be abandoned, but they are necessary for the treatment of atypical depression.

Depression treatment methods

The problem of diagnosing “depression with a smile” also follows from the problem of diagnosis. Not all antidepressant groups are equally effective. For example, monoamine oxidase inhibitors (MAOIs) are found to be much more potent in this form of depression than tricyclic antidepressants (TCAs). But with respect to selective serotonin reuptake inhibitors (SSRIs) there are different data on the effectiveness of different drugs. Naturally, only a doctor who will take into account all the nuances of atypical depression and select the most effective drug should prescribe medications.

Among other methods of dealing with “smiling depression”, doctors and scientists call physical activity and meditation. Thus, according to studies conducted in the United States, over 8 weeks of meditation in combination with regular physical exertion, it was possible to reduce the level of atypical depression by 40%. The cognitive-behavioral therapy shows good results in the treatment of this condition.

Psychiatrists recommend that people with atypical depression set life goals for themselves, and try to divert their attention from themselves and transfer it to someone else. It can be volunteering , caring for a loved one, even caring for a pet. Doctors emphasize that for people with atypical depression it is especially important to have a purpose in life and meaning. This affects both the mental health of a person and his life as a whole.

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