Can daytime sleepiness be diagnosed as depression? A brief discussion on the lesser-known "atypical" depression

This is the 3435th article of Da Yi Xiao Hu

Recently, a piece of news about a high school girl who was diagnosed with depression due to daytime sleepiness and excessive sleep has sparked heated discussions among netizens: Sasha (pseudonym), a high school girl from Guangzhou, often dozed off in class recently. Even on weekends, she still felt tired after sleeping until noon. The doctor conducted a detailed examination and evaluation of Sasha and found that she was depressed. In fact, increased sleep can also be one of the "atypical" manifestations of depression or depressive mood. Depressive mood characterized by this kind of manifestation is called "atypical" depression.

"Atypical" depression accounts for about 15% of depression patients. The difference between it and typical depression patients lies in the different symptoms. Typical depression is manifested as "three lows": low mood (bad mood), slow thinking (slow reaction, "blank" mind), reduced and slowed behavior, and also includes sleep disorders (early awakening, shallow sleep, easy awakening or difficulty falling asleep), fatigue, loss of appetite (reduced food intake), memory loss, etc. In general, the symptoms of typical depression are mostly "low, slow, and less". The symptoms of "atypical" depression are less common, including: increased appetite, drowsiness, restlessness, lead-like paralysis (severe fatigue to the point of feeling heavy hands and feet). In addition, unlike the uncontrollable depression of typical depression, the depression of "atypical" depression patients will be alleviated by good things happening around them and happy events, but once these things are over, the patients will feel depressed again. The interpersonal relationships of such patients can be maintained for a long time, instead of avoiding interpersonal communication like typical depression patients.

Of course, simply having some of the above symptoms cannot prove that one suffers from atypical depression. For example, simple sleepiness and increased appetite for a period of time may be related to recent life events. It may be that the heavy workload and study lead to physical fatigue and then eating a lot. So how do we judge whether the abnormal behavior is related to depression? We need to keep in mind that the core of depression is still depressive mood. Patients have self-blame and self-guilt (feeling useless, dragging down family and friends), pessimism and negativity (feeling that the world around them is gloomy, there is no hope for the future, and life is meaningless), etc., and "atypical" symptoms such as sleepiness and increased appetite persist, and are not affected by surrounding things. Although the patient's sleep time has increased, he still appears listless during the day. These manifestations are different from normal changes in life status and can help yourself and the people around you to identify them.

In fact, these "atypical" depressive manifestations are often misdiagnosed or ignored, and people think that they are not depression or depression. Just like the case of the girl mentioned above, her main symptom is sleepiness, while most patients with depression often have varying degrees of insomnia. Therefore, the girl's diagnosis has aroused discussion and confusion among netizens. Similarly, some people who do not seem to be depressed, and even give people an optimistic and cheerful impression in interpersonal communication, actually have an unexpected "other side" and may suffer from depression, such as the famous comedians Rowan Atkinson (Mr. Bean) and Gene Kelly. This type is also called "smiling depression."

"Atypical" depression needs our attention because of its characteristics. A clinical study targeting Chinese patients concluded:

1) Atypical depression is more likely to lead to suicidal tendencies and suicide attempts;

2) More likely to be accompanied by psychotic symptoms;

3) The age of onset is earlier than that of typical depression;

4) The likelihood of a lifetime of depression increases and there are more seasonal depressive episodes.

Overseas studies have also pointed out that the disease is more common in women and is often comorbid with anxiety. From the summary of this study, the prognosis and severity of "atypical" depression are more serious than typical depression. Timely and effective diagnosis and treatment, and delays in diagnosis and treatment may also be one of the reasons for the poor prognosis of "atypical" depression. Therefore, when you and the people around you have a fake smile, increased sleep, and abnormal appetite, you should not take it lightly.

Although we cannot effectively prevent the occurrence of "atypical" depression, when you find yourself or your relatives and friends showing symptoms, you can refer to the following four suggestions:

1) Slowly try to grasp and control your stress.

2) Actively seek help from relatives and friends, which is especially important when you are feeling very depressed.

3) Seek professional help as soon as possible to prevent symptoms from getting worse.

4) Follow the advice of professional doctors and adhere to long-term treatment.

As the public pays more and more attention to depression, more patients with depression are getting help. However, there is still a group of "atypical" patients with depression under the shadow of the sun. They look like "sunshine", but the warmth cannot reach their hearts. I hope this article can benefit everyone. When you are busy, don't forget to care more about your relatives and friends, find "atypical" patients with depression around you in time, seek medical treatment and treatment in time, and accompany, help and support them. It is their warmest "sunshine".

Author: Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine

Department of Psychological Medicine