Melancholic depression

Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-V subtype of clinical depression.

Melancholic depression
Meditation by Domenico Fetti 1618
SpecialtyPsychiatry
SymptomsLow mood, low self-esteem, fatigue, insomnia, anorexia, anhedonia, lack of mood reactivity, worse mood in the morning[1]
ComplicationsSelf harm, suicide
Usual onsetEarly adulthood
CausesGenetic, environmental, and psychological factors
Risk factorsFamily history, trauma,
TreatmentCounseling, antidepressant medication, electroconvulsive therapy

Signs and symptoms

Requiring at least one of the following symptoms:

  • Anhedonia (the inability to find pleasure in positive things)
  • Lack of mood reactivity (i.e. mood does not improve in response to positive events)

And at least three of the following:

  • Depression that is subjectively different from grief or loss
  • Severe weight loss or loss of appetite
  • Psychomotor agitation or retardation
  • Early morning awakening
  • Guilt that is excessive
  • Worse mood in the morning

Melancholic features apply to an episode of depression that occurs as part of either major depressive disorder or bipolar disorder I or II.[2]

Causes

The causes of melancholic-type major depressive disorder are believed to be mostly biological factors; some may have inherited the disorder from their parents. Sometimes stressful situations can trigger episodes of melancholic depression, though this is a contributing cause rather than a necessary or sufficient cause. People with psychotic symptoms are also thought to be more susceptible to this disorder. It is frequent in old age and often unnoticed by some physicians who perceive the symptoms to be a part of dementia. Major depressive disorder, melancholic or otherwise, is a separate condition that can be comorbid with dementia in the elderly.[3]

Treatment

Melancholic depression is often considered to be a biologically based and particularly severe form of depression.[4] Treatment involves antidepressants, electroconvulsive therapy, or other empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression.[5] A 2008 analysis of a large study of patients with unipolar major depression found a rate of 23.5% for melancholic features.[4] It was the first form of depression extensively studied, and many of the early symptom checklists for depression reflect this.

Incidence

The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.[6] According to the DSM-IV, the "melancholic features" specifier may be applied to the following only:

  1. Major depressive episode, single episode
  2. Major depressive episode, recurrent episode
  3. Bipolar I disorder, most recent episode depressed
  4. Bipolar II disorder, most recent episode depressed
gollark: To be fair, some people probably weren't managing well, but that's no reason to do this to everyone.
gollark: I was basically fine with the "not much supervision, you get set work" thing, but this is just stupid.
gollark: I mean, I was fine with working remotely. I could get more done, did not have to bother with (as much) busy-work, had a flexible schedule, sort of thing.
gollark: It seems like they just completely disregarded the benefits of asynchronous communication, and decided that they had to make it as much like normal in-person school as possible, even despite the detriment to... actually teaching things.
gollark: I got an email from them (not even to me directly, forwarded from my parents) and:- the removed week of the summer term is being added to the end- they seem to expect to reopen in a month or so?- half the lessons will apparently now involve "human interaction", implying video calls or something, which will be *really annoying*, instead of having them just set work- they're running a timetable?!- I'm expected to be up by 08:45⸘

See also

References
  1. https://www.healthline.com/health/depression/melancholic-depression#symptoms
  2. Diagnostic and Statistical Manual of Mental Disorders - Text Revision. Arlington VA: American Psychiatric Publishing. 2008. pp. 419–420. ISBN 978-0-89042-025-6.
  3. Pekker, Michael. "Clinical Depression: Symptoms and Treatments". Retrieved 12 October 2011.
  4. McGrath, Patrick; Ashan Khan; Madhukar Trivedi; Jonathan Stewart; David W Morris; Stephen Wisniewski; Sachiko Miyahara; Andrew Nierenberg; Maurizio Fava; John Rush (2008). "Response to a Selective Serotonin Reuptake Inhibitor (Citalopram) in Major Depressive Disorder with Melancholic Features: A STAR*D Report". Journal of Clinical Psychiatry. 69: 1847–1855. doi:10.4088/jcp.v69n1201.
  5. Luty, Suzanne; Carter, Janet; McKenzie, Janice (2007). "Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression". The British Journal of Psychiatry. 190: 496–502. doi:10.1192/bjp.bp.106.024729.
  6. Radua, Joaquim; Pertusa, Alberto; Cardoner, Narcis (28 February 2010). "Climatic relationships with specific clinical subtypes of depression". Psychiatry Research. 175 (3): 217–220. doi:10.1016/j.psychres.2008.10.025. PMID 20045197.
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