What is melancholic depression? Symptoms, diagnosis, and more

Via Peters

Most research sources list melancholia as a form of major depressive disorder, but there is still some controversy over this particular diagnosis.

The scientific community does not agree on whether melancholic depression is a distinct type or subtype of depression or a severe symptom of this condition.

This article discusses what melancholic depression is, melancholy versus depression, the history of melancholia, symptoms of melancholic depression, and how doctors diagnose and treat it.

According to the Centers for Disease Control and Prevention (CDC), 30.2% of adults in the United States experience symptoms of depression. It is a mood disorder that causes persistent low moods and can affect a person’s ability to carry out everyday activities such as working, eating, and sleeping. Many different types of depression can develop for various reasons, such as life events, seasonal changes, or a person’s menstrual cycle.

Researchers believe melancholic depression affects 25–30% of people with depression. Additionally, research from 2015 suggests that melancholia may have links to unique brain changes not observable in people with other forms of depression. For example, the above research discusses a reduced connection between the insula — part of the cerebral cortex in the brain — and the frontoparietal cortex.

A 2017 summary of the structure and function of the insula states that it plays a part in sensory processing, empathy, decision making, mood regulation, and mediating the exchange of information to other brain regions.

The frontoparietal cortex coordinates behavior and helps with cognitive control.

Research has also found that when people with melancholic depression watch emotionally charged films, they have reduced connectivity in regions of the brain associated with nonreactive mood. This was in contrast to participants with nonmelancholic depression, who showed increased connectivity.

The above 2012 article writes that healthcare professionals historically treated depression with rest, talk therapy, amphetamines, meprobamate, and benzodiazepines. Doctors commonly use antidepressants to treat the condition. However, they often recommend treating melancholia with somatic therapy, electroconvulsive therapy (ECT), and tricyclic antidepressants.

Research has yet to conclude whether melancholic depression is a distinct type of depression or a symptom of severe clinical depression. Currently, official diagnostic guidelines state it is a symptom of severe depression.

Melancholia is a historical term for depression. For over 2,000 years, experts considered melancholia a type of movement disorder. This is because it may affect psychomotor skills and cause slowed or agitated movements.

Historically, melancholia describes a group of symptoms, including:

In the 1970s and 1980s, researchers argued that melancholic depression was a distinct form of depression rather than a symptom of the condition. This is because melancholic depression has the following features:

The above 2012 article describes that, in the DSM-3 from 1980, mental health care practitioners combined melancholic depression into one category: major depression.

The DSM-5, from 2013, continues to state that melancholic depression is not a separate diagnosis from clinical depression. Instead, healthcare professionals use melancholy as a specifier — a descriptive word for adding clarity to a person’s diagnosis.

Presently, mental health care professionals consider melancholic depression a symptom of severe clinical depression. As a result, the symptoms a person may experience align with those relating to clinical depression.

The symptoms of clinical depression include:

  • a loss of pleasure or interest in activities a person usually enjoys
  • feeling hopeless, worthless, guilty, or sad
  • trouble thinking, finding concentrating or making decisions hard
  • thoughts of suicide or death

Studies that consider melancholic depression distinct from clinical depression state that an individual may experience the following symptoms:

However, these symptoms may also present in clinical depression.

Learn more about what depression feels like.

A mental health care professional diagnoses depression by asking detailed questions about someone’s symptoms, medical history, family medical history, and history of substance use and misuse.

A doctor should also perform a complete physical examination, which includes a neurological and mental status exam.

To rule out underlying causes of depression, a doctor may order blood or other tests to assess a person’s levels of:

According to the CDC, suicide is the twelfth leading cause of death in the United States.

The National Institute of Mental Health (NIMH) recommends a person tries the following if they or someone they know is at risk of suicide:

  • limiting access to lethal weapons, such as guns, or medications, such as prescription or over-the-counter pills and poisons
  • learning ways to cope with depression symptoms
  • building and engaging a strong social support network and people to talk with
  • receiving supportive follow-up or scheduled calls with suicide prevention networks or organizations
  • cognitive behavioral therapy, dialectical behavior therapy, or both
  • treating substance misuse problems
  • some antipsychotic medications, in particular, clozapine
  • store the number for the National Suicide Prevention Lifeline (1-800-273-TALK (8255)) into a phone and call when necessary
  • text the Crisis Text Line (text HELLO to 741741) when feeling overwhelmed by suicidal thoughts

Warning signs of suicide include:

  • talking about wanting to harm or kill themselves
  • talking about the desire to die or be dead
  • talking about feeling hopeless, empty, trapped, being a burden to others, or not having a reason to live
  • becoming withdrawn socially
  • getting legal or other affairs in order, such as making a will
  • engaging in behavior that can result in bodily harm or death
  • saying goodbye to family or friends.
  • giving away prized or valuable possessions for no clear reason, such as downsizing or moving
  • misusing substances
  • experiencing intense mood swings
  • obtaining lethal weapons or stockpiling medications
  • showing rage or talking about getting revenge

If someone attempts suicide or is in a severe state of emotional or mental distress, a person should call emergency services and wait until first responders arrive. Alternatively, they can try to take them to the nearest hospital.

Mental health authorities and the DSM-5 list melancholic depression as a feature or symptom of major depressive disorder. However, some research advocates for the reclassification of melancholic depression as a distinct type of depression.

If a person is experiencing melancholy as part of depression, they should speak with a doctor or other mental health care professional. There are medications, therapy, and other types of treatment that are effective for depression.


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