An Overview of Melancholic Depression

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Melancholic depression is a form of major depressive disorder (MDD) that is characterized by a profound presentation of severe depression. With this form of depression, there is a complete loss of pleasure in all or almost everything. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), melancholia is a specifier for MDD—so a person would be diagnosed as having major depressive disorder (the broader illness) with melancholic features (the specific symptoms). 

While melancholic depression is no longer considered a separate, distinct diagnosis, some researchers suggest that it should be considered a distinct syndrome in order to improve treatments and outcomes.

The term "melancholia" is one of the oldest terms used in psychology. It has been around since Hippocrates introduced it in the fifth century B.C., and it means "black bile" in Greek. The translation is fitting because Hippocrates believed that an excess of black bile (one bodily fluid out of the "Four ​Humours," as he called them) caused melancholia.

The symptoms Hippocrates categorized under melancholia are nearly identical to the symptoms we use today for melancholic depression, including fear, not wanting to eat, insomnia, restlessness, agitation, and sadness.

Symptoms 

Symptoms of melancholic depression include:

  • A distinct quality of depressed mood characterized by profound despondency, despair, or emptiness
  • Depression that is consistently worse in the morning
  • Early morning waking (at least two hours earlier than normal)
  • Psychomotor disturbances of either retardation, which is the slowing of normal movement, or agitation, which is increased and/or irregular movement
  • Anorexia or weight loss
  • Excessive or inappropriate guilt

Causes 

The start of these episodes is usually not caused by a specific event. Even when something good happens, the individual's mood does not improve—not even for a short time. 

Older people, inpatients, and those who exhibit psychotic features are at greater risk for melancholic depression.

The exact causes of depression are not clear, but genetics, family history, past trauma, brain chemistry, and hormones may all play a role. Melancholic depression, however, is believed to have strong biological origins.

One neuroimaging study found that a key "signature" marker was only seen in participants with melancholic depression but was not observed in those with non-melancholic depression or in those without depression.

Diagnosis

A doctor will start with an evaluation to assess the nature, severity, and duration of your symptoms. Some of the questions they may ask include:

  • Has your daily routine changed?
  • Do you still enjoy the things you used to like doing?
  • Do you have trouble getting out of bed in the morning?
  • How do you sleep?
  • Are your symptoms worse in the morning?
  • Is it difficult for you to concentrate?
  • Is there anything that helps improve your mood?

A doctor will also evaluate your physical health and may perform some tests or blood work to check that your symptoms are not related to some type of underlying medical condition.

In order to be diagnosed with melancholic depression, an individual must exhibit symptoms of major depressive disorder such as:

To be diagnosed with melancholic features, you must have at least three of these symptoms:

  • Depression that is different from grief
  • Weight loss or loss of appetite
  • Slowed activity or restlessness
  • Excessive guilt
  • Waking much earlier than normal
  • More severe depressive symptoms in the morning

A doctor will also rule out other conditions including:

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see our National Helpline Database.

Treatment 

For melancholic depression, medication is often part of the treatment plan because it is believed to have a biological root. In other words, since it is usually not triggered by outside circumstances, causes of melancholic depression appear to be mainly due to genetic makeup and brain function, necessitating a medication that works on biological causes like brain function.

Types of antidepressants that may be used for melancholic depression include:

Research suggests that melancholic depression responds better to tricyclic antidepressants than to SSRIs, psychotherapy, or social interventions. 

Coping

Because melancholic depression is characterized by such profound feelings of sadness, loss of pleasure, and lack of interest in daily activities, it can create major disruptions in how a person is able to function in many areas of life.

If you suspect that you have melancholic symptoms, you should talk to a doctor. Antidepressants are the first line of treatment for this condition and can be very effective. There are, however, some things that you can do to help manage your symptoms and complement medication-based treatments.

Lifestyle modifications that may help improve your mood include:

It is important to remember, however, that the symptoms of melancholic depression can make all of these things very difficult. Once your medications begin to take effect, you may find it easier to start incorporating these changes into your daily routine.

Online resources and support groups may also be helpful for managing your symptoms of melancholic depression. Talk to a doctor to decide if this is a good option to complement your other treatments.

A Word From Verywell

Melancholic depression can have a serious impact on your work, school, social, and home life. Fortunately, there are effective treatments that can help. If you have symptoms of depression, talk to a doctor who can rule out other causes and recommend treatment options that can help you regain balance.

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6 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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