A 34-year-old woman presents with a 3-week history of depressed mood, anhedonia, 6 kg weight gain, hypersomnia, and profound fatigue that is worse in the morning but improves slightly by evening. She reports feeling 'leaden' heaviness in her limbs that lasts for hours. She has had two previous depressive episodes. Which specifier best describes her current episode?

• A With melancholic features
• B With anxious distress
• C With catatonic features
• D With atypical features ✓

Explanation

Atypical features specifier requires mood reactivity as the core criterion, plus at least two of: hypersomnia, hyperphagia, leaden paralysis, and long-standing interpersonal rejection sensitivity. This patient demonstrates weight gain, hypersomnia, and leaden paralysis — classic atypical features. Melancholic features, by contrast, involve mood that is worse in the morning, early morning awakening, and loss of pleasure that does not improve even briefly with positive events.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.