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m I edited the symptoms section to better define the symptoms and added a sentence at the end on which cases it's most likely to be present in.
Ciil18 (talk | contribs)
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I added to the causes and lead sections, as well as briefly to symptoms. I also created a new classification section.
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'''Melancholic depression''', or '''depression with melancholic features''', is a [[DSM-IV]] and [[DSM-5]] specifier of [[depressive disorders]].
'''Melancholic depression''', or '''depression with melancholic features''', is a [[DSM-IV]] and [[DSM-5]] specifier of [[depressive disorders]]. This type of depression has specific symptoms that make it different from the standard clinical depression list of symptoms.<ref>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=Fifth Edition |language=en |doi=10.1176/appi.books.9780890425596}}</ref>

== Classification ==
'''Depression with melancholic features''' is classified under the fourth and fifth versions [[Diagnostic and Statistical Manual of Mental Disorders|Diagnostic and Statistic Manual of Mental Disorders]] ([[DSM-IV]] and [[DSM-5]]) as a specifier of [[depressive disorders]].<ref>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=Fifth Edition |language=en |doi=10.1176/appi.books.9780890425596}}</ref> A specifier essentially is a subcategory of a disease, explaining specific features or symptoms that are added to the main diagnosis.<ref>{{Cite web |date=2017-05-17 |title=What’s the DSM-5? |url=https://psychcentral.com/lib/dsm-5 |access-date=2023-03-28 |website=Psych Central |language=en}}</ref>


==Signs and symptoms==
==Signs and symptoms==
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* Worse depressed mood in the morning
* Worse depressed mood in the morning
Melancholic features apply to an episode of depression that occurs as part of either [[major depressive disorder]], [[dysthymia|persistent depressive disorder (dysthymia)]], or [[bipolar disorder]] [[Bipolar I disorder|I]] or [[Bipolar II disorder|II]].<ref name="DSM-5">
Melancholic features apply to an episode of depression that occurs as part of either [[major depressive disorder]], [[dysthymia|persistent depressive disorder (dysthymia)]], or [[bipolar disorder]] [[Bipolar I disorder|I]] or [[Bipolar II disorder|II]].<ref name="DSM-5">
{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|year=2013|publisher=American Psychiatric Publishing|location=Arlington VA|isbn=978-0-89042-559-6}}</ref> They are more likely to occur in patients with milder cases and in patients who suffer from [[Psychotic depression|depression with psychotic features]].
{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|year=2013|publisher=American Psychiatric Publishing|location=Arlington VA|isbn=978-0-89042-559-6}}</ref> They are more likely to occur in patients with milder cases and in patients who suffer from [[Psychotic depression|depression with psychotic features]].<ref>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=Fifth Edition |language=en |doi=10.1176/appi.books.9780890425596}}</ref> People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech.<ref>{{Cite web |date=2022-11-03 |title=Melancholic Depression: Symptoms, Diagnosis, Treatment, and Coping Tips |url=https://psychcentral.com/depression/melancholic-depression |access-date=2023-03-28 |website=Psych Central |language=en}}</ref>


==Causes==
==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.<ref>{{cite web|last=Pekker|first=Michael|title=Clinical Depression: Symptoms and Treatments|url=http://depressivedisorder.blogspot.co.uk/2011/01/melancholic-depression-causes-symptoms.html|access-date=12 October 2011}}</ref>
The causes of melancholic-type [[major depressive disorder]] are believed to be mostly biological factors; some may have inherited the disorder from their parents. Some studies have found that there are [[Biomarker|biological marker]] differences between patients with melancholic depression and other subtypes of depression.<ref>{{Cite journal |last=Spanemberg |first=Lucas |last2=Caldieraro |first2=Marco Antonio |last3=Vares |first3=Edgar Arrua |last4=Wollenhaupt-Aguiar |first4=Bianca |last5=Kauer-Sant'Anna |first5=Márcia |last6=Kawamoto |first6=Sheila Yuri |last7=Galvão |first7=Emily |last8=Parker |first8=Gordon |last9=Fleck |first9=Marcelo P. |date=2014-08-19 |title=Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure |url=https://www.dovepress.com/biological-differences-between-melancholic-and-nonmelancholic-depressi-peer-reviewed-fulltext-article-NDT |journal=Neuropsychiatric Disease and Treatment |language=English |volume=10 |pages=1523–1531 |doi=10.2147/NDT.S66504}}</ref> 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.<ref>{{Cite web |title=Melancholic Depression: Causes, Symptoms, and Treatment {{!}} Clinical Depression: Symptoms and Treatment |url=http://depressivedisorder.blogspot.com/2011/01/melancholic-depression-causes-symptoms.html |access-date=2023-03-28 |website=Melancholic Depression}}</ref>

Physicians often do not notice the symptoms in patients of old age because they 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.<ref>{{cite web|last=Pekker|first=Michael|title=Clinical Depression: Symptoms and Treatments|url=http://depressivedisorder.blogspot.co.uk/2011/01/melancholic-depression-causes-symptoms.html|access-date=12 October 2011}}</ref>

The research regarding melancholic depression consistently finds that men are more likely to receive a melancholic depression diagnosis.<ref>{{Cite journal |last=Gili |first=Margalida |last2=Roca |first2=Miquel |last3=Armengol |first3=Silvia |last4=Asensio |first4=David |last5=Garcia-Campayo |first5=Javier |last6=Parker |first6=Gordon |date=2012-10-26 |title=Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3482206/ |journal=PLoS ONE |volume=7 |issue=10 |pages=e48200 |doi=10.1371/journal.pone.0048200 |issn=1932-6203 |pmc=3482206 |pmid=23110213}}</ref>


==Treatment==
==Treatment==
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==Incidence==
==Incidence==
The incidence of having the melancholic depression specifier among patients with clinical depression is estimated to be about 25% to 30%. People who suffer from melancholic depression do not need to have melancholic features in every depressive episode.<ref>{{Cite web |title=The Darkest Mood: Major Depression With Melancholic Features {{!}} Psychology Today |url=https://www.psychologytoday.com/us/blog/and-running/202110/the-darkest-mood-major-depression-melancholic-features |access-date=2023-03-28 |website=www.psychologytoday.com |language=en-US}}</ref>
⚫
The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.<ref name=radua2010>

⚫
The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.<ref name="radua2010">
{{Cite journal
{{Cite journal
| last1 = Radua | first1 = Joaquim
| last1 = Radua | first1 = Joaquim

Revision as of 04:49, 28 March 2023

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

Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-5 specifier of depressive disorders. This type of depression has specific symptoms that make it different from the standard clinical depression list of symptoms.[2]

Classification

Depression with melancholic features is classified under the fourth and fifth versions Diagnostic and Statistic Manual of Mental Disorders (DSM-IV and DSM-5) as a specifier of depressive disorders.[3] A specifier essentially is a subcategory of a disease, explaining specific features or symptoms that are added to the main diagnosis.[4]

Signs and symptoms

Melancholic depression requires at least one of the following symptoms during the last depressive episode:

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

And at least three of the following:

  • Depressed mood that is subjectively different from grief or loss (marked by despair, gloominess, and "empty-mood")
  • Severe weight loss or loss of appetite
  • Psychomotor agitation or retardation (i.e. increased or decreased movement, speech, and cognitive function)
  • Early morning awakening (i.e. waking up at least 2 hours before the normal wake up time of the patient)
  • Guilt that is excessive
  • Worse depressed mood in the morning

Melancholic features apply to an episode of depression that occurs as part of either major depressive disorder, persistent depressive disorder (dysthymia), or bipolar disorder I or II.[5] They are more likely to occur in patients with milder cases and in patients who suffer from depression with psychotic features.[6] People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech.[7]

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. Some studies have found that there are biological marker differences between patients with melancholic depression and other subtypes of depression.[8] 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.[9]

Physicians often do not notice the symptoms in patients of old age because they 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.[10]

The research regarding melancholic depression consistently finds that men are more likely to receive a melancholic depression diagnosis.[11]

Treatment

Melancholic depression is often considered to be a biologically based and particularly severe form of depression.[12] Treatment involves antidepressants and empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression.[13] A 2008 analysis of a large study of patients with unipolar major depression found a rate of 23.5% for melancholic features.[12] It was the first form of depression extensively studied, and many of the early symptom checklists for depression reflect this.

Electroconvulsive therapy (ECT) was previously believed to be an effective treatment for melancholic depression, however studies since the 2000s have failed to demonstrate positive treatment results from ECT.[14][15]

Incidence

The incidence of having the melancholic depression specifier among patients with clinical depression is estimated to be about 25% to 30%. People who suffer from melancholic depression do not need to have melancholic features in every depressive episode.[16]

The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.[17] 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

See also

References

  1. ^ "Melancholic Depression: Symptoms, Treatment, Tests and More". 26 March 2012.
  2. ^ American Psychiatric Association (2013-05-22). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8. {{cite book}}: |edition= has extra text (help)
  3. ^ American Psychiatric Association (2013-05-22). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8. {{cite book}}: |edition= has extra text (help)
  4. ^ "What's the DSM-5?". Psych Central. 2017-05-17. Retrieved 2023-03-28.
  5. ^ Diagnostic and Statistical Manual of Mental Disorders. Arlington VA: American Psychiatric Publishing. 2013. ISBN 978-0-89042-559-6.
  6. ^ American Psychiatric Association (2013-05-22). Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8. {{cite book}}: |edition= has extra text (help)
  7. ^ "Melancholic Depression: Symptoms, Diagnosis, Treatment, and Coping Tips". Psych Central. 2022-11-03. Retrieved 2023-03-28.
  8. ^ Spanemberg, Lucas; Caldieraro, Marco Antonio; Vares, Edgar Arrua; Wollenhaupt-Aguiar, Bianca; Kauer-Sant'Anna, Márcia; Kawamoto, Sheila Yuri; Galvão, Emily; Parker, Gordon; Fleck, Marcelo P. (2014-08-19). "Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure". Neuropsychiatric Disease and Treatment. 10: 1523–1531. doi:10.2147/NDT.S66504.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ "Melancholic Depression: Causes, Symptoms, and Treatment | Clinical Depression: Symptoms and Treatment". Melancholic Depression. Retrieved 2023-03-28.
  10. ^ Pekker, Michael. "Clinical Depression: Symptoms and Treatments". Retrieved 12 October 2011.
  11. ^ Gili, Margalida; Roca, Miquel; Armengol, Silvia; Asensio, David; Garcia-Campayo, Javier; Parker, Gordon (2012-10-26). "Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions". PLoS ONE. 7 (10): e48200. doi:10.1371/journal.pone.0048200. ISSN 1932-6203. PMC 3482206. PMID 23110213.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  12. ^ a b 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 (12): 1847–1855. doi:10.4088/jcp.v69n1201. PMID 19026268.
  13. ^ 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 (6): 496–502. doi:10.1192/bjp.bp.106.024729. PMID 17541109.
  14. ^ Rasmussen, Keith G. (December 2011). "Electroconvulsive Therapy and Melancholia: Review of the Literature and Suggestions for Further Study". The Journal of ECT. 27 (4): 315–322. doi:10.1097/YCT.0b013e31820a9482. ISSN 1095-0680. PMID 21673591.
  15. ^ Rush, Gavin; O’Donovan, Aoife; Nagle, Laura; Conway, Catherine; McCrohan, AnnMaria; O’Farrelly, Cliona; Lucey, James V.; Malone, Kevin M. (November 2016). "Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy". Journal of Affective Disorders. 205: 60–68. doi:10.1016/j.jad.2016.06.035. ISSN 0165-0327. PMC 5291160. PMID 27414954.
  16. ^ "The Darkest Mood: Major Depression With Melancholic Features | Psychology Today". www.psychologytoday.com. Retrieved 2023-03-28.
  17. ^ 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. S2CID 21764662.
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