Atypical depression treatment without medication with natural cures and remedies

Atypical Depression

©  2010  Peter Smith
–Holistic Medicine Practitioner- (updated February 2015)

Atypical depression is not uncommon as the name implies and it’s believed this subtype of depression may constitute up to 40% of all cases of clinical depression.

Do You Have Atypical Depression?

In addition to the usual signs of depression (including intense sadness, despair etc. lasting more than 2 weeks) with atypical depression there are some distinguishing features:

With atypical depression the persons mood can temporarily brighten and they come out of the depression in response to good news, doing something fun or receiving emotional comfort and support from other people; the improvement in mood is not sustained and they quickly descend back into depression. This is known as mood-reactivity and is a key distinguishing feature or specifier for atypical depression [i]. This is in contrast to people with melancholic depression who are unable to react positively to positive news and remained depressed all the time irrespective of side events, comfort etc. 
{ARTIST: slowlydying @}

In addition to the mood-reactivity atypical depression includes at least two of the following symptoms persisting for more than 2 weeks:

Significant sensitivity to rejection and criticism (rejection-hypersensitivity) to the extent that it impairs one’s ability to interact with others either socially or occupationally.
Significant increased need for sleep (hypersomnia). Hypersomnia is needing to sleep more than 10 hours a day or 2 hours more than normal.
Significant increased appetite, sometimes especially for carbohydrates so weight gain can be a problem.
Significant heavy leaden feelings in the arms and legs, tiredness.
Atypical depression typically fails to respond at all to tricyclic antidepressants and often does not respond well to SSRIs, which suggests it involves a different underlying mechanism.
Atypical depression often has an early age of onset, it’s more prevalent in women and can often coexists with anxiety disorders.

Summary of Atypical Depression

Atypical depression is characterised by: a depressed mood that temporarily lifts with good news and comfort from others (mood reactivity), significant sensitivity to rejection (rejection sensitivity), lethargy, tiredness, excessive sleeping, there may be a delayed sleep cycle with difficulty waking up in the morning (as opposed to the difficulty sleeping and early rising seen in other types of depression) heavy limbs,increased appetite, overeating (consequently weight gain), lack of response to tricyclic antidepressants and to a lesser extent SSRIs.
It’s easy to get so caught up in the definitions of the different types of psychological problems, in precisely which type of problem you have that we end up losing sight of the purpose of making a medical diagnosis and that is to point us in the direction of the best treatment, with natural remedies long as you’re not mixing them with conventional drugs and it’s a safe and appropriate time for you to be trying something new you can test the effectiveness of the treatment without the risk of toxic side-effects. Also individual people often have complex mixtures of symptoms that don’t neatly fit into a single textbook definition, I suggest you simply use the different definitions simply as guides to point you in the direction of the underlying problem and then by experimenting with natural remedies you can develop your own unique combination of remedies to suit your individual brain.
When I meet a patient that describes having the symptoms above I first want to establish that we are looking at depression and rule in or out that they the possibility that they have an underactive thyroid, adrenal exhaustion or chronic fatigue syndrome, unfortunately of course people don’t fit into neat textbook categories and it’s possible to have multiple conditions at the same time. If it looks like depression and a brain issue genuinely involved the characteristic lethargy and excessive sleeping makes me think the underlying cause may be a lack of dopamine and or PEA activity in the brain not serotonin. I’ll say more about this below.

The Brain Chemistry of Atypical Depression

Originally the concept of atypical depression was born out of the observation that MAOI antidepressants could treat it whereas tricyclic antidepressants would not, for a while when SSRIs (e.g. Prozac) were first introduced there was such confidence that this new generation of antidepressants could treat all kinds of depression that interest in atypical depression decreased; however SSRIs have not been reliably shown to be more effective at treating atypical depression[ii] and the distinction of atypical depression as a subtype of people with depression is regaining interest.
The leaden limbs and excessive sleeping seen in atypical depression are also characteristic of chronic fatigue syndrome and hypothyroidism therefore care must be taken to differentiate and not misdiagnose these conditions. Chronic fatigue syndrome and hypothyroidism do not include mood reactivity, rejection sensitivity and overeating, they also do not respond to MAOIs. Chronic fatigue syndrome reacts extremely badly to exercise however in my practice I get great results by combining exercise with amino acid therapy with atypical depression. Chronic fatigue syndrome and atypical depression do not include reduced basal temperature and thyroid hormones. See Thyroid and Depression for more information.
The neurotransmitter serotonin is calming, it’s the precursor (building block) for the sleep inducing hormone melatonin and it helps us sleep. Therefore when you have reduced serotonin activity you can have difficultysleeping both falling asleep and characteristic early waking some people have with typical depression. When you take excessive amounts of the amino acid tryptophan to boost serotonin production it increases your propensity to sleep I often prescribe tryptophan for insomnia; when I personally experimented with very high doses of tryptophan as an antidepressant it made me sleep deeply for an excessively long time and continued to make me feel drowsy the next day albeit with a mellow and happy mood, many of my patients have had similar experiences and had to reduce their dosage. With atypical depression people are already sleeping excessively and feel lethargic they just don’t look like they need more serotonin. Furthermore serotonin-based antidepressants SSRIs have not consistently shown themselves to be more effective than MAOIs at treating atypical depression.
Even when SSRIs do work it may not necessarily be because they increased serotonin. There’s a growing theory that the way antidepressant SSRIs work is not because they boost serotonin but also because they repair and regenerate the brain. SSRIs reduce elevated levels of inflammatory chemicals called cytokines that damage critical structures within brain and increase the level of a protective chemical called brain derived neurotrophic factor BDNF. A major source of inflammatory cytokines is hyperactivity of the stress response which is a known phenomenon in depression.  You can reduce the overproduction of stress responses within 3 months brain training see the stress solution on the self-help pages on my website .
The theory that antidepressants work by regenerating damaged brain structures actually explains why they don’t work instantly and it takes several weeks before one feels any benefit. The ability of SSRIs to promote regeneration in the brain may also explain why some people with atypical depression can find them beneficial since improved brain health may restore more than just the serotonin pathways.
MAOIs on the other hand increase the activity of dopamine and the little-known phenylethylamine (see PEA Deficient Depression). My clinical observations of the years lead me to believe that atypical depression does not primarily or perhaps at all involve imbalances in the neurotransmitter serotonin.

So if atypical depression does not involve a deficiency or imbalance in serotonin what does it involve?

The sleepy and lethargic character of atypical depression makes me think of an imbalance in the neurotransmitters: PEA (phenylethylamine) and or Dopamine are more likely candidates than serotonin. However as I’ve said elsewhere you can have an imbalance in more than one neurotransmitter at the same time brain chemistry is complex in different people can respond differently to the same treatment for you need to conduct your own individual treatment trials, see treating atypical depression below.

PEA is a little-known and overlooked neurotransmitter, it’s the brains natural amphetamine, it gives us psychological energy and has a fast acting antidepressant effect; it also acts as a modulator of other neurotransmitters stimulating the release of serotonin and dopamine. PEA activity has been shown to be diminished in people with atypical depression however we cannot conclude too much from this because reduced PEA activity is not exclusively seen in people with atypical depression and is also observed in other types of depression except interestingly dysthymic depression (mild a very long term depression).
Encouragingly increasing PEA activity in the brain can be effective in cases of depression that have been resistant to standard approaches.

Dopamine gives the brain drive, motivation, excitement about new things and life’s pleasures; when you take it away you lack energy, interest in life, motivation and just want to sleep a lot.

It’s hard to interpret the mood-reactivity and rejection-hypersensitivity features of atypical depression in terms of specific neurotransmitters however based on my observations over the years I’ve developed impressions of the characteristics of the different neurotransmitters. I associate the absolute bleakness and inability to experience joy observed in melancholic depression with a very low serotonin condition, although with low serotonin you can be extremely sensitive to outside news the reactivity is more         to bad news which makes you feel even worse rather than good news temporarily making feel better is seen atypical depression.
Although atypical depression and bipolar syndrome are different they both involve an unstable up and down mood and I suspect the neurotransmitter PEA may play a role in both conditions. Research has shown PEA activity is highly variable in bipolar syndrome[iii] and that changing levels of PEA activity may trigger the switch between mania and depression in people with rapid cycling bipolar syndrome [iv]; furthermore increases in PEA activity produce very rapid elevations in depressed moods and PEA has a very short lifespan before it is broken down. The very fast acting and moods switching potential characteristics of PEA make me suspect plays a central role in atypical depression. Unfortunately research into the neurotransmitter PEA has been chronically underfunded and it appears it’s connection to atypical depression has not been investigated. Using safe natural remedies however you can test it for yourself.
N.B. Just to make things even more complicated it’s possible to have bipolar syndrome and atypical depression. Basically this would involve having bipolar depression with the same features as atypical depression combined with manic episodes.

Treating Atypical Depression with Natural Remedies

The observation that atypical depression responds to MAOIs but not to other types of antidepressants and that MAOIs inhibit the breakdown of the overlooked neurotransmitter phenylethylamine or PEA has led some people to suggest that the cause of atypical depression is underline deficiency of PEA activity and I suggest that if you have atypical depression you try my natural PEA increasing protocol
If boosting the neurotransmitter PEA is not entirely successful move on and  try boosting dopamine on its own then in combination with the PEA protocol, then you could try boosting serotonin on its own or in combination with PEA and or dopamine.
In addition to boosting your PEA and/or dopamine levels with atypical depression you should also try the following:
1/ Chromium picolinate 1000 µg a day divided between 2 or 3 meals.I’ve had people write to me sharing their personal experiences of chromium supplementation producing significant therapeutic antidepressant effects and you can find quite a lot of anecdotal evidence suggesting chromium can be antidepressant, perhaps even being effective in cases of so-called treatment resistant depression which is depression that has failed to respond to at least two rounds of different antidepressants.
Initially I thought chromium was only useful for improving the symptom of carbohydrate craving which can be a part of depression particularly atypical depression and that by improving blood sugar balance chromium may exert an indirect effect on brain chemistry involved in depression; however it appears chromium may have far wider therapeutic effects than blood sugar control and carbohydrate craving alone.
It seems that chromium may enhance the transportation of tryptophan across the blood brain barrier and as I’ve explained elsewhere (see Serotonin Deficient Depression) one of the main things limiting serotonin levels is the availability of tryptophan (the building block of serotonin), however it should be noted that from animal studies this effect only appears to be significant when the animals are diabetic[i]. Furthermore there is some evidence from human studies that chromium may directly modify brain serotonin function by altering the sensitivity of specific serotonin receptors.
The bulk of the evidence seems to connect chromium’s potential antidepressant effects to situations where there is also an imbalance in blood sugar either insulin resistance or diabetic spectrum so if you have any degree of imbalance blood sugar control and depression you should definitely try using chromium as part of your treatment along with an anti diabetic diet obviously.
You can buy a blood glucose meter quite cheaply to test if you have either high fasting blood sugar first thing in the morning or if your blood sugar goes too high or stays high too long after meals (see Blood Sugar Control), if your blood sugar values are anything other than completely optimal chromium combined with the right diet exercise and possible weight loss may treat your condition.
Even if your blood sugar levels are optimal chromium is relatively cheap and completely safe when taken the therapeutic levels so it’s another option for you to try.

2/ Anecdotally some people find:
B6 in the form of P-5-P (20-150 mg a day, avoid taking too much B6 in the evening as it can disturb sleep with excessively vivid dreams) and
Zinc (I recommend L-OptiZinc 30-60 mg).
To balance a large dose of B6 you should also take a B complex and at least a trace of iron and copper in a multimineral to prevent the zinc antagonising and depleting you of copper and iron.
(Iron should not be taken by people with cancer).
3/ Last but by no means least the good psychotherapy can significantly diminish the painful and debilitating hypersensitivity to rejection experienced with atypical depression.

4/ Bright Light Therapy Contrary to popular belief bright light therapy is not just for people with seasonal affective disorder (SAD syndrome) or winter blues it can be an effective treatment for any type of depression, however people with bipolar depression such as myself must only use bright light therapy with the appropriate safeguards to prevent it from flipping you into mania. Bright light therapy has an energising antidepressant effect which is perfect for the sleepy lethargic nature of atypical depression.
You can use bright light therapy at any time throughout the day up until 3-4 hours before wanting to sleep for an energising and antidepressant effect however if your 24-hour sleep cycle is late running (delayed sleep phase syndrome, DSPS) it’s very important to make your firstexposure to the bright light therapy very early in the day ideally as soon as you wake up to reset your internal biological clock (suprachiasmatic nucleus). If you want to learn more about taking control of the timing of your 24 hours sleep cycles see the 2nd half of my book Sleep Better with Natural Therapies available from Amazon. I’m currently working on a book on treating bipolar syndrome with natural therapies with another on depression to follow that.

The original in my view now old-fashioned bright light therapy devices were enormous boxes with bright fluorescent tubes in them, however we now know that there are specific cells in the eyes (photosensitive retinal ganglion cells) responsible for setting the biological clock and telling us when to wake up and go to sleep and these cells only see blue/cyan green light so the new bright light therapy devices emit blue/cyan green light and are more compact and more efficient. You’ll find a page on how to choose and use a bright light therapy device on my new site

The other incredibly important implication of the photosensitive retinal ganglion cells being sensitive to blue light is that modern devices including flatscreen TVs, laptops tablets and smartphones expose our eyes to bright blue light in the evening, our brain perceives this as a bright blue sky and not right time to release the sleep hormone melatonin and fall asleep.
It only takes a few minutes of exposure to bright blue light to switch off melatonin production and delay sleep for several hours so don’t expose yourself to bright blue light within 3 hours of wanting to go to sleep. If the photosensitive retinal ganglion cells could see all the colours of the rainbow to switch the brain into nighttime sleep mode we have switch off our electrical devices and read a book by a candle, thankfully however they can only see blue so all we have to do is to block blue light by wearing amber coloured glasses for 2 ½ ideally 3 hours before we want to sleep and then we can use our electrical devices at the same time, I’m wearing my blue blocking glasses as I write this and within an hour or so I’ll feel a pleasant wave of sleepiness hitting me from a surge in melatonin levels. In my book I give additional techniques to enhance and maximise melatonin production.

I know that getting to sleep is not a problem for people with atypical depression but if you having the problem of a delayed 24 hours sleep cycle and find it difficult to go to sleep on time which then makes it even harder to wake up on time the combination of bright blue light in the morning with blue blocking glasses in the evening can reset your 24-hour sleep cycle.  

Beyond Neurotransmitters

There’s more to fixing a mental health problem than simply boosting the level of a specific neurotransmitter in the synapses, we need to improve the health of the synapses and the overall brain itself for the neurotransmitters to work properly. 

See Beyond neurotransmitters restoring the fundamental health of the brain

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See also:

Major Depression

Dysthymic Depression
Atypical Depression
Melancholic Depression
Postpartum Depression
Seasonal Affective Disorder
Bipolar Depression

General References
[ *Clinical Features of Treatment Resistant Depression Krnestein & Schneider, Journal of clinical psychiatry 2001]
[** Liebowitz, Quitki, Stewart, et. al. Antidepressant specificity in atypical depression Arch Gen Psychiatry 1988]
[i] Psychiatry (Edgmont). 2006 Apr; 3(4): 33–39. Published online 2006 Apr. PMCID: PMC2990566
Atypical Depression Tanvir Singh, MDcorresponding author and Kristi Williams, MD
[ii] Nierenberg AA, Alpert JE, Pava J, et al. Course and treatment of atypical depression. J Clin Psychiatry. 1989;59(suppl 18):5–9. [PubMed]. Reference source from Psychiatry (Edgmont). 2006 Apr; 3(4): 33–39. Published online 2006 Apr. PMCID: PMC2990566. Atypical Depression Tanvir Singh, MD and Kristi Williams, MD Author information 
[iii] Natural Medications for Psychiatric Disorders David Mischouon and Gerald Rosenbaum (the 2002 addition with the red cover) page 95. This is the only good source of information on PEA I can find.
[iv] J Nerv Ment Dis. 1988 Feb;176(2):116-9. Increase in urinary beta-phenylethylamine preceding the switch from mania to depression: a "rapid cycler". Semba J1, Nankai M, Maruyama Y, Kaneno S, Watanabe A, Takahashi R.
[v] J Psychiatr Pract. 2005 Sep;11(5):302-14. A double-blind, placebo-controlled, exploratory trial of chromium picolinate in atypical depression: effect on arbohydrate craving. Docherty JP1, Sack DA, Roffman M, Finch M, Komorowski JR.
[i] Biol Trace Elem Res. 2012 Oct;149(1):50-6. doi: 10.1007/s12011-012-9393-x. Epub 2012 Mar 22. Chromium picolinate modulates serotonergic properties and carbohydrate metabolism in a rat model of diabetes. Komorowski JR1, et al PMID: 22434381 DOI: 10.1007/s12011-012-9393-x
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Hi my name is Peter Smith I specialise in treating and coaching people how to live well with mental health problems, digestive health problems/IBS, sleep problems and type II diabetes using natural therapies.
I used these techniques to overcome and live well with my own bipolar disorder and IBS. I've been in practice as a natural medicine practitioner since 1988.

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Another way you could contribute to this site by helping me with the proofreading. People regularly point out that there’s a large number of errors on my site which I find quite embarrassing, but I’m quite dyslexic and I don’t notice them myself.
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