Examining Features of Atypical Depression in Youth From the Texas Youth Depression and Suicide Research Network Research Registry

Objective Atypical depression is a depression subtype characterized by atypical and energy-related symptoms such as hypersomnia, weight gain, fatigue, and leaden paralysis. Limited research has examined its clinical characteristics in youth. This study investigates the prevalence, sociodemographic and clinical correlates, and 6-month depression trajectories of atypical depression in a statewide youth depression registry.MethodData from youth 11 to 20 years of age from the Texas Youth Depression and Suicide Research Network (TX-YDSRN), a registry of youth with depression or suicidal ideation, were analyzed. Atypical depression was defined using the Atypical Energy-Related Symptom (AES) Scale (score of ≥6). Sociodemographic data, body mass index (BMI), depression and anxiety severity, suicidality, trauma history, and physical functioning were compared between individuals with atypical and non-atypical depression. Mixed-effects models were used to assess depressive symptom trajectories over 6 months.ResultsOf 1,445 participants (mean age = 15.8 years, 72.8% female), 22.4% had atypical depression. Atypical depression was associated with greater baseline depression, anxiety, suicidality, and suicide attempts compared with non-atypical depression. Atypical depression was associated with female sex, trauma history, and obesity. Youth with atypical depression also had poorer physical functioning. Over 6 months, individuals with atypical depression exhibited persistently higher depressive severity compared with those with non-atypical depression.ConclusionAtypical depression in youth is associated with more severe clinical profiles and worse depression trajectories relative to non-atypical depression. Future studies should investigate the temporal relationships between variables such as trauma, obesity, and the onset of atypical depression to better understand how these factors may precede or exacerbate atypical depression.Plain language summaryData were collected from youth aged 11 to 20 years enrolled in the Texas Youth Depression and Suicide Research Network (TX-YDSRN) registry study. In the sample of 1,445 youth, 22.4% had atypical depression. Experiencing atypical depression in youth was associated with more severe clinical features and worse depression trajectories over 6 months relative to non-atypical depression. Identifying distinct clinical profiles can inform the design of targeted clinical trials for youth with atypical features and potentially lead to improved treatment outcomes.