¿Qué es la depresión atípica?

Para la mayoría de las personas que experimentan síntomas médicos extraños que no parecen ir de la mano, obtener un diagnóstico es un alivio. Finalmente, las piezas del rompecabezas crean un todo que parece familiar, al menos para un médico.

Pero un diagnóstico que contenga la palabra "atípico" podría dejarlo un poco incómodo. Finalmente tienes una respuesta, ¿y el problema es que eres anormal? Qué útil.

In the case of atypical depression, that's a little misleading. Atypical depression doesn't translate to "depression for weirdos" -- it's a very specific subset of the mental health disorder, with careful criteria for diagnosis. All "atypical" means here is that some of its symptoms are the opposite of what doctors had come to expect with depression.

Melancholic depression is what most people mean when they talk about being depressed. You can't sleep, you can't eat. You can't concentrate on anything. And nothing seems to bring you out of it. Things that used to make you smile leave you feeling empty.

With atypical depression, some of those symptoms are reversed. Patients oversleep (hypersomnia), overeat (hyperphagy) and exhibit mood reactivity -- they're able to brighten up in response to happy news; it just doesn't last long. Because of that latter quality, they may not even know they're depressed. They may think that their baseline of depression is just how everyone feels.

They do know, however, that feeling like your limbs are so incredibly heavy that you can't move is not normal. This symptom, leaden paralysis, is different from a lack of energy -- it's more like being physically anchored to your bed. With actual metal anchors.

La depresión atípica tiende a aparecer bastante temprano, en la adolescencia y en la adultez temprana, y es más común en las mujeres.

También tiende a tener compañía no deseada. Las personas con depresión atípica tienen más probabilidades de tener ansiedad , trastorno de personalidad y somatización (síntomas físicos sin causa física) que aquellas con otros tipos de depresión. También es más probable que tengan problemas con el abuso de sustancias.

El primer paso para encontrar el tratamiento adecuado es obtener el diagnóstico correcto. Entonces, ¿cómo puede saber con seguridad si esta es la etiqueta correcta para usted o para un ser querido?

La depresión "con características atípicas" se incluyó en el DSM-IV en 1994, que es el equivalente a "tuitear" en Merriam-Webster en 2011. El Manual diagnóstico y estadístico de los trastornos mentales es la guía oficial para los profesionales de la psique. . También es parte de cómo las compañías de seguros de salud determinan si tienen que pagar por sus terapias o no.

Los criterios del DSM-IV para diagnosticar un episodio de depresión atípica requieren, ante todo, que la persona tenga reactividad del estado de ánimo, lo que significa que, en ocasiones, puede sentirse hasta un 50 por ciento mejor en respuesta a un evento feliz.

También especifica que el paciente presenta dos de estos cuatro síntomas: comer en exceso, dormir demasiado, parálisis plomiza y sensibilidad al rechazo que afecta la calidad de vida.

Rejection sensitivity is one of the more interesting aspects of atypical depression. People who exhibit this symptom have serious work and social troubles because they overreact to any hint of criticism or rejection. Instead of taking a boss's comments in stride, they may go into a full-blown depressive episode. The terror of being rejected makes it very difficult for them to have romantic relationships and maintain friendships; a small slight or off-hand comment can validate their worst fears.

The other symptoms are, perhaps, easier to quantify. Overeating can be measured by a weight gain of 5 pounds (2.27 kilograms) or more. Oversleeping can be defined by sleeping 10 hours a day (counting naps) or 2 hours more than usual on a regular basis. Leaden paralysis usually lasts for an hour or more a day.

Algunos lo compensan estableciendo horarios rígidos de sueño y comidas y evitando las relaciones. Pero cerrar las brechas para sentirse bien no hace que esos agujeros desaparezcan.

Entonces, ¿cómo se tratan los síntomas que hacen que la vida cotidiana sea tan difícil?

La depresión atípica es exigente con su tratamiento. Los médicos descubrieron hace décadas que, a diferencia de otras formas de depresión , no respondía a los antidepresivos tricíclicos (TCA) ni a la terapia electroconvulsiva (que tiene mala reputación pero puede ser muy útil para las personas con depresión resistente al tratamiento). Más bien, la depresión atípica parecía responder solo a un tipo de fármaco: los inhibidores de la monoaminooxidasa o IMAO .

MAOIs work. Sometimes, they're the only thing that works for people whose depression has defied every other type of pill on the market. The problem is their side effects. They can cause very high blood pressure, leading to cardiac arrhythmia, brain hemorrhage and even heart failure. People on MAOIs have to follow a very strict diet absent of all foods containing an amino acid called tyramine, which includes, among many others, miso soup, sauerkraut, pepperoni, powdered protein supplements, pickled herring, cheese, Chianti, draft beer and vermouth (just to give you an idea of what to serve at a bizarre, tyramine-themed dinner party) [sources: Hall-Flavin; UPMC].

Because of the potential side effects, MAOIs have largely gone out of fashion and are no longer considered a first-line treatment. Luckily, newer antidepressants, such as selective serotonin-reuptake inhibitors (SSRIs) like fluoxetine (Prozac, Sarafem, Rapiflux, Selfemra) and sertraline (Zoloft), work for atypical depression.

If they don't cut it, however, MAOIs are still available. Phenelzine (Nardil) is the only one that's indicated specifically for atypical depression, and in studies, it's the drug that's shown the greatest effectiveness.

Treatment isn't all pills, either. An important double-blind, placebo-controlled (as in, the best kind) study from 1999 showed that cognitive therapy was just as effective as phenelzine in bringing relief to those with major depressive disorder and atypical depression [source: Jarrett]. (Cognitive therapy focuses on changing a person's distorted perceptions and creating new behavior patterns.) This is great news for someone resistant to taking medication, but psychotherapy should ideally be included in any treatment depression treatment plan, pills or no.

More, More, More

People with atypical depression don't crave just any food -- it's carbs in particular that they desire. Some studies show that chromium supplements help cut down on the pasta mania [source: Docherty et al.].

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