Research progress of sleep disturbance in patients with atypical depression

doi:10.3969/j.issn.1674-8115.2026.02.014

Abstract

Abstract:

Atypical depression (AD) is a subtype of depression characterized by emotional reactivity, excessive sleep, increased appetite, and interpersonal sensitivity. The prevalence of excessive sleep in AD patients is significantly higher than that in patients with typical depression. Patients have characteristics such as prolonged total sleep time, poor sleep quality, and abnormal sleep structure, which are closely related to prolongation of the disease course, increased risk of recurrence, and poor treatment response. Imbalances in neurotransmitters, elevation of inflammatory factors, and disorders of the hypothalamic-pituitary-adrenal axis are considered core pathological mechanisms related to sleep disturbance in AD. Existing diagnostic tools for AD have deficiencies, thus necessitating the integration of sleep disturbance characteristics, biomarkers, and neuroimaging findings to optimize diagnostic strategies. Given the complexity and heterogeneity of AD-related sleep disturbance in terms of clinical manifestations, pathogenesis, and treatment, in-depth research requires interdisciplinary integration and collaboration. This article reviews the clinical features, pathological mechanisms, and current treatment strategies of sleep disturbances in atypical depression.

Key words: atypical depression (AD), sleep disturbance, clinical features, pathological mechanisms, treatment strategies

CLC Number:

R749.4

Fang Wen, Zhang Haonan, Yang Tao, Chen Jun, Fang Yiru. Research progress of sleep disturbance in patients with atypical depression[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(2): 241-247.

TrendMD

References 39

[1]	American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Arlington: American Psychiatric Association, 2013.
[2]	Brailean A, Curtis J, Davis K, et al. Characteristics, comorbidities, and correlates of atypical depression: evidence from the UK Biobank Mental Health Survey[J]. Psychol Med, 2020, 50(7): 1129-1138.
[3]	Cheung M M S, Lam S P, Chau S W H, et al. Hypersomnolence is associated with non-remission of major depressive disorder[J]. Sleep Med, 2024, 119: 35-43.
[4]	Hein M, Lanquart J P, Loas G, et al. Prevalence and risk factors of excessive daytime sleepiness in major depression: a study with 703 individuals referred for polysomnography[J]. J Affect Disord, 2019, 243: 23-32.
[5]	Chen Y, Zhang L F, Hu S F, et al. Status and correlates of hypersomnia in hospitalized patients with unipolar depression: Beijing, Henan, and Shandong, China, August 2019‒March 2021[J]. China CDC Week, 2021, 3(42): 879-882.
[6]	Bhachech H, Nath K, Sidana R, et al. Personalized approach in the management of difficult-to-treat and treatment-resistant depression with second-generation antipsychotics: a Delphi statement[J]. Cureus, 2024, 16(1): e52878.
[7]	Pearson O, Uglik-Marucha N, Miskowiak K W, et al. The relationship between sleep disturbance and cognitive impairment in mood disorders: a systematic review[J]. J Affect Disord, 2023, 327: 207-216.
[8]	Carey M G, Al-Zaiti S S, Dean G E, et al. Sleep problems, depression, substance use, social bonding, and quality of life in professional firefighters[J]. J Occup Environ Med, 2011, 53(8): 928-933.
[9]	Rethorst C D, Greer T L, Toups M P, et al. IL-1β and BDNF are associated with improvement in hypersomnia but not insomnia following exercise in major depressive disorder[J]. Transl Psychiatry, 2015, 5(8): e611.
[10]	Sunderajan P, Gaynes B N, Wisniewski S R, et al. Insomnia in patients with depression: a STAR*D report[J]. CNS Spectr, 2010, 15(6): 394-404.
[11]	Kwaśna J, Kwaśny A, Wilkowska A, et al. Residual hypersomnia in unipolar and bipolar depression: a systematic review[J]. World J Biol Psychiatry, 2024, 25(10): 575-591.
[12]	Manwaring J L, Blalock D V, Duffy A, et al. An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: an attempt to increase diagnostic clarity[J]. Int J Eat Disord, 2024, 57(4): 848-858.
[13]	Antonietta Furio M, Popovic D, Vieta E, et al. Characterization of rapid cycling bipolar patients presenting with major depressive episode within the BRIDGE-Ⅱ-MIX study[J]. Bipolar Disord, 2021, 23(4): 391-399.
[14]	Thase M E. Atypical depression: useful concept, but it's time to revise the DSM-Ⅳ criteria[J]. Neuropsychopharmacology, 2009, 34(13): 2633-2641.
[15]	Scott J, Byrne E, Medland S, et al. Short communication: self-reported sleep-wake disturbances preceding onset of full-threshold mood and/or psychotic syndromes in community residing adolescents and young adults[J]. J Affect Disord, 2020, 277: 592-595.
[16]	Rumble M E, White K H, Benca R M. Sleep disturbances in mood disorders[J]. Psychiatr Clin N Am, 2015, 38(4): 743-759.
[17]	Pandi-Perumal S R, Monti J M, Burman D, et al. Clarifying the role of sleep in depression: a narrative review[J]. Psychiatry Res, 2020, 291: 113239.
[18]	Fornaro M, Caiazza C, Pistone L, et al. Atypical depression and emotion dysregulation: clinical and psychopathological features[J]. J Affect Disord, 2025, 376: 410-421.
[19]	Magen E L, Geishin A, Weizman A, et al. High rates of mood disorders in patients with chronic idiopathic eosinopenia[J]. Brain Behav Immun Health, 2024, 40: 100847.
[20]	Belanger H G, Lee C, Poliacoff Z, et al. Early response to antidepressant medications in adults with major depressive disorder: a naturalistic study and odds of remission at 14 weeks[J]. J Clin Psychopharmacol, 2023, 43(1): 46-54.
[21]	Spanagel R, Pendyala G, Abarca C, et al. The clock gene Per2 influences the glutamatergic system and modulates alcohol consumption[J]. Nat Med, 2005, 11(1): 35-42.
[22]	Olivier B, Olivier J D A. Efficacy, safety, and tolerability of psychedelics in treatment-resistant depression (TRD)[M]//Kim Y K.Recent advances and challenges in the treatment of major depressive disorder. Singapore: Springer Nature Singapore, 2024: 49-66.
[23]	Milaneschi Y, Lamers F, Berk M, et al. Depression heterogeneity and its biological underpinnings: toward immunometabolic depression[J]. Biol Psychiatry, 2020, 88(5): 369-380.
[24]	Refisch A, Sen Z D, Klassert T E, et al. Microbiome and immuno-metabolic dysregulation in patients with major depressive disorder with atypical clinical presentation[J]. Neuropharmacology, 2023, 235: 109568.
[25]	Chae W R, Baumert J, Nübel J, et al. Associations between individual depressive symptoms and immunometabolic characteristics in major depression[J]. Eur Neuropsychopharmacol, 2023, 71: 25-40.
[26]	Applewhite B, Penninx B W J H, Young A H, et al. The effect of a low-calorie diet on depressive symptoms in individuals with overweight or obesity: a systematic review and meta-analysis of interventional studies[J]. Psychol Med, 2024, 54(8): 1671-1683.
[27]	Adewuya A O, Coker O A, Atilola O, et al. Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria[J]. Arch Women's Ment Health, 2018, 21(6): 591-599.
[28]	Kim J H, Cho M J, Hong J P, et al. Gender differences in depressive symptom profile: results from nationwide general population surveys in Korea[J]. J Korean Med Sci, 2015, 30(11): 1659.
[29]	Tran K, Mcgill S C, Horton J. Bupropion for treatment-resistant depression[J]. Cjht, 2021, 1(4): 7-17.
[30]	Patarroyo-Rodriguez L, Pazdernik V, Vande Voort J L, et al. Hypersomnia as a predictor of response to intravenous ketamine/intranasal esketamine in treatment resistant depression[J]. J Affect Disord, 2024, 349: 272-276.
[31]	Badini I, Coleman J R I, Hagenaars S P, et al. Depression with atypical neurovegetative symptoms shares genetic predisposition with immuno-metabolic traits and alcohol consumption[J]. Psychol Med, 2022, 52(4): 726-736.
[32]	Younis I R, Gopalakrishnan M, Mathis M, et al. Association of end point definition and randomized clinical trial duration in clinical trials of schizophrenia medications[J]. JAMA Psychiatry, 2020, 77(10): 1064.
[33]	Robillard R, Carpenter J S, Feilds K L, et al. Parallel changes in mood and melatonin rhythm following an adjunctive multimodal chronobiological intervention with agomelatine in people with depression: a proof of concept open label study[J]. Front Psychiatry, 2018, 9: 624.
[34]	Geoffroy P A, Palagini L. Biological rhythms and chronotherapeutics in depression[J]. Prog Neuro Psychopharmacol Biol Psychiatry, 2021, 106: 110158.
[35]	Chung K F, Lee C T, Au C H, et al. Cognitive behavioural therapy for insomnia as an early intervention of mood disorders with comorbid insomnia: a randomized controlled trial[J]. Early Interv Psychiatry, 2024, 18(2): 82-93.
[36]	Tamaki K, Saito N, Tomita H. Serum 3-hydroxybutyrate is expected to serve as one of the supportive diagnostic markers of persistent idiopathic dentoalveolar pain (PDAP)[J]. J Pain Res, 2023, 16: 4005-4013.
[37]	Morita Y, Takahashi K, Ohshima S, et al. Is vestibular Meniere's disease associated with endolymphatic hydrops?[J]. Front Surg, 2020, 7: 601692.
[38]	Munagama C L, Rajendiran V, Silva S. A case report on a common tumour with an uncommon presentation: glioblastoma[J]. Cureus,2024, 16(8): e66830.
[39]	Said O, Stringer D, Sengun Filiz E, et al. Olanzapine for young PEople with aNorexia nervosa (OPEN): results of a feasibility study[J]. BMC Psychiatry, 2024, 24(1): 779.