Atypical Depression Vs Melancholia

Atypical Depression Vs Melancholia

	Atypical Depression	Melancholia
Mood Reactivity	Reactive	Pervasive anhedonia
Appetite	Increased	Decreased
Sleep	Increased	Decreased
Energy	Leaden Paralysis	Low without Leaden Paralysis
Premorbid Personality	Rejection Sensitive	Normal Sensitivity

Q. Young female pt
C/C: fatigue
HOPI: For past 2-3 weeks, c/o profound tiredness, increased need for sleep & increased appetite. These symptoms started after a break up with her boyfriend.
Pt's symptoms rapidly improved after she reunited with her boyfriend.

What is the diagnosis:
(a) Bipolar disorder with rapid cycling
(b) Borderline personality disorder
(c) Major depression with Atypical features.

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Answer: Major depression with Atypical features
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Explanation:
This is an important question, because "Major depression with Atypical features" is the most common subtype of depression (so more chances of questions on this topic on PRITE & related exams).

Look for following points:
(1) Mood brightens in response to actual or potential positive events (Compared to Melancholic subtype: mood doesn't brighten even in response to positive events).
(2) 2 or more of following features:
- Significant weight gain/increase in appetite
- Hypersomnia
- Leaden paralysis (heavy, leaden feelings in arms & legs)
- Long standing pattern of interpersonal rejection sensitivity that results in significant social & occupational impairment.



DSM IV Criteria for Atypical Depression:
(a) Meets criteria for major depression or dysthymia
(b) Significant mood reactivity
(c) >2 of the following:
- Hyperphagia
- Hypersominia
- Mood reactivity
- Leaden Paralysis
(d) Does not meet criteria for Melancholia or Catatonic features.