Most research sources list melancholia as a form of major depressive disorder, but there is still some controversy over this particular diagnosis.
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.
Melancholic depression is a mental health condition, although there is debate around whether it is a distinct form of depression or a symptom of severe depression.
According to the American Psychological Association (APA), melancholia is an old word for depression.
Currently, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) considers melancholia a symptom of severe clinical depression. However, some research, such as these pieces from
According to the
Researchers believe melancholic depression affects
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
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
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
- has certain unique symptoms or features
- has links to aspects of someone’s characteristics more than psychosocial factors
- does not respond to placebo medications
- has better management outcomes with antidepressant medications and ECT than psychotherapy
- has a potential genetic component
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:
- weight changes
- changes in appetite
- reduced libido, or sexual desire
- psychomotor agitation, a feeling of anxious restlessness
- reduced cognitive function
However, these symptoms may also present in clinical depression.
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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.
To rule out underlying causes of depression, a doctor may order blood or other tests to assess a person’s levels of:
People with melancholic symptoms
Additionally, individuals may typically
They also noted that SNRIs were more effective than SSRIs.
Since the DSM-5 views melancholia as a symptom of severe clinical depression, other treatments for depression may also help.
Common treatments for this condition include:
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.
According to the CDC, suicide is the
- 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.