A 45-year-old woman presents with persistent depressed mood, hypersomnia (sleeping 14 hours/day), increased appetite with carbohydrate craving, weight gain of 5 kg, and extreme sensitivity to interpersonal rejection, resulting in significant occupational impairment. There is NO seasonal pattern, NO bipolar history. The appropriate DSM-5 specifier for this depressive episode is:

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

Explanation

DSM-5 'With atypical features' specifier requires: mood reactivity (mood brightens in response to positive events) PLUS at least two of: significant weight gain or increased appetite, hypersomnia, leaden paralysis, or long-standing interpersonal rejection sensitivity. The classic picture is hypersomnia, hyperphagia, leaden heaviness, and rejection sensitivity. This is distinct from melancholic features (characterised by anhedonia, morning worsening, early morning awakening, psychomotor changes, excessive guilt — classically associated with TCA response). Atypical depression historically shows preferential response to MAOIs over TCAs.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.