Why is no one talking about atypical depression?

Recently something amazing happened. After years of feeling that my chronic depression is somehow inauthentic or inadequate in some way, I read an article which changed my perspective and alleviated some of my feelings of not quite belonging to the genuine depression club.

The article describes something called smiling or atypical depression, and literally every line of the article resonated with me. I’ve often felt like a fraud when I think about or describe my depressive feelings to others, and this article helped me understand why.

The symptoms of atypical depression

Atypical or smiling depression is characterised by a tendency to hide one’s real feelings of low mood and hopelessness, taking pains to look like a ‘normal’, happy person on the outside.

According to the article, those with atypical depression “may seem like they don’t have a reason to be sad — they have a job, an apartment and maybe even children or a partner. They smile when you greet them and can carry pleasant conversations. In short, they put on a mask to the outside world while leading seemingly normal and active lives.”

This is me. But the bit that really got me was this: “Although people with smiling depression put on a ‘happy face’ to the outside world, they can experience a genuine lift in their mood as a result of positive occurrences in their lives.”

I’ve been known to feel a surge of warmth and a fleeting sense of joy at being alive when surrounded by family or enjoying a sunny day. This high can last a few hours, before the feeling of emptiness inevitably returns.

I won’t recite the whole article but here’s where I can recognise myself in the symptoms:

• Overeating: this is a biggie for me and how my depression manifests most obviously.
• Heaviness in the body: my general excess girth doesn’t help with this but sometimes it feels like even my head is too heavy to lift out of bed.
• Over-sensitivity to criticism and rejection: big tick here; receiving criticism makes me feel rejected, and rejection leads to overeating and self-loathing, and so on.
• Feelings of depression being particularly noticeable in the evenings: evenings are when I feel most hopeless, and often the only way that sense of hopelessness can be subdued is through eating.
• Needing to sleep longer than usual: my husband will testify to my awesome ability to hit the snooze button over and over again until I’ve given myself the least amount of time possible to get up, shower, get dressed and shove the kids out the door before arriving at work with a minute to spare.

The atypically depressed type

I also recognise myself completely in the description of certain temperaments more likely to suffer with smiling depression: those who anticipate failure more keenly than others, struggle to process and get over embarrassing situations, and overthink everything negative that has happened or might happen in the future.

I see these character traits as mere symptoms of a deeper psychological fear though: fear of rejection. The reality is I can’t handle being rejected. Even if I haven’t yet been rejected, the thought of possibly being rejected from something in the future is too much for me to deal with. I don’t know why; I can’t pinpoint a defining event in my childhood which has led to these feelings of inadequacy, but there again I am the typical atypically depressed.

So why the silence surrounding atypical depression?

For something which is apparently quite common, I hadn’t heard of this form of depression before I read that eye-opening article. I’ve done a lot of research into it since, and it seems that people with atypical depression may respond better to a different type of antidepressant medication, known as monoamine oxidase inhibitors (MAOIs), rather than the typical SSRIs and SNRIs which I’ve taken for the best part of two decades.

However, MAOIs evidently have the potential for more serious side effects and there are specific dietary restrictions to adhere to when taking them. Perhaps that is why health professionals may be reluctant to consider atypical depression when diagnosing a patient. I certainly was never alerted to this form of depression when asked about my symptoms by the multitude of doctors and therapists I’ve spoken with over the years, despite my symptoms aligning very closely with it.

Coping with atypical depression

As well as the perpetual fear of rejection, which has affected my working life and relationships to varying extents, I feel that there is something else that is ‘wrong’ deep down inside, not on the surface level which can be seen by others. And this is where the article became ingrained in my mind forever, as it gives two suggestions to help break the cycle:

1. Recognising that this is a real condition, so potentially serious that it can lead to higher suicide rates than typical depression due to sufferers not allowing their feelings to be validated by others or themselves. Reading this has allowed me to recognise my depression as being a real condition, not something I’m making up through a lack of anything else substantial enough to occupy my racing brain. So I’m going to see if I can get some counselling tailored to sufferers of atypical depression.
2. Finding meaning and purpose in one’s life — something which I feel is lacking in my life. Yes, I’m a mum and happy to be one, as well as a wife, sister and daughter. But I feel I have more to offer to others or to the world. Funnily enough, before I read this article I had already reasoned that I might feel happier by taking the focus off myself completely and being less self-indulgent. I don’t think of myself as an egotistical person and I always have great empathy and consideration for others. But actually I’ve realised that this constant ruminating and self-analysing isn’t doing me any good and could actually be wasting time and potential which could be dedicated to helping others. I suspect that through this I might conversely find some meaning to my life which could lead to greater contentment.

Moving forwards after a diagnosis

So, after I’ve pretty much recited the contents of the entire article (as I said I wouldn’t!), I can only thank the authors for bringing this to my attention and allowing my feelings to be validated. I’d like to think that I might also be able to more readily spot atypical depression in others.

I’m going to plough on with my plans to find some purpose and meaning in my life by trying to help others, and sourcing some specialised counselling. I hope also that sharing this post might help highlight this valid and serious condition to others who also recognise themselves here.

If this does ring any bells with you at all please comment below and let me know. As with all forms of depression the suffering is often made more bearable by knowing you’re not alone.

Sarah Bones