Melancholic depression

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Melancholic depression
Accademia - La Meditazione by Domenico Fetti 1618.jpg
Meditation by Domenico Fetti 1618
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 subtype of clinical depression.

Signs and symptoms[edit]

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]


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]


Melancholic depression is often considered to be a biologically based and particularly severe form of depression.[4] Treatment involves antidepressants and 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.

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.[6][7]


The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.[8] 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[edit]


  1. ^ "Melancholic Depression: Symptoms, Treatment, Tests and More". 26 March 2012.
  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. ^ 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.
  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 (6): 496–502. doi:10.1192/bjp.bp.106.024729. PMID 17541109.
  6. ^ 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.
  7. ^ 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.
  8. ^ 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.