Atypical depression in bipolar affective disorder: a clinical case study

Abstract

Atypical depression (AtD) is contrasted with classical endogenous melancholic depression and is characterized by the presence of its uncharacteristic abnormalities, but the list of the latter varies from individual symptoms (increased appetite, weight gain, drowsiness, weakness, and anxiety) and their concurrence to syndromes accompanying depression (anxiety-phobic, obsessive-compulsive, panic attacks, derealization-depersonalization, hypochondriacal syndrome). In accordance with the DSM-5 diagnostic criteria, AtD is a symptom complex that includes mood reactivity and at least two of the following symptoms: hyperphagia, hypersomnia, lead-palsy, and personality sensitivity. AtD has been described within a variety of disorders: recurrent depressive disorder, bipolar affective disorder, dysthymia, cyclothymia, and psychogenic depression. The paper describes a clinical case of atypical depressive syndrome within the framework of type 2 bipolar disorder in a 51-year-old patient. AtD was concurrent with dermatitis herpetiformis (Dühring's disease) in some depressive episodes; it was accompanied by various somatic complaints in other cases. The latest episode of AtD occurred during the COVID-19 pandemic and included obvious reactive anxiety-phobic disorders. A detailed clinical and psychopathological analysis of history data, mental state, and ongoing therapy was carried out, which clearly reflects difficulties in the differential diagnosis of AtD and the use of adequate treatment.