Melancholic depression, a major depressive disorder, is characterized by overwhelming feelings and guilt and a loss of interest in your usual activities.
Melancholic depression can cause problems at work, school, and in relationships. The treatment usually involves a combination of therapy and medication.
What is Melancholic Depression?
Melancholic depression, often known as melancholia, is a severe depression. It has various unique symptoms, such as intense, persistent feelings like hopelessness, guilt, and a loss of enjoyment from life. It a separate disorder from other forms of depression.
About 25 to 30 percent of depression sufferers have negative symptoms. Whether melancholy is a subtype or a unique syndrome has been the subject of heated discussion among mental health professionals.
Melancholia is a term that dates back several millennia. It stems from an ancient theory that it is due to imbalances in the four senses of humor or internal bodily fluids.
Doctors believed that imbalances in the blood, yellow bile, and phlegm could cause many diseases thousands of years ago. Black bile, also known as melancholia from the Greek for “blues,” was considered to cause depression in people.
New medical research has disproved this. The term melancholia is used to characterize this specific form of depression.
Symptoms of melancholic depression
The signs of melancholic melancholy are very close to those of severe depression. Most people experience some or all of these symptoms:
- Persistent sadness and emptiness
- Activity that was once enjoyed is no longer of interest
- Not being able or unable to sleep enough
- Eating too much or not eating enough
- Feeling tired or lacking energy
- Feeling guilty or worthless
- Having difficulty concentrating or making decisions
- Feel the changes in your body’s movement and thinking
A person suffering from melancholic depression might also be affected by MDD.
- Extremely negative emotions, such as shame or despair
- Suicide or death: Thinking about it
- Suicide or death thoughts
- Focused on one thought or image
- Delusions or hallucinations relate to guilt, shame, disease, impending doom, and others.
These symptoms can be severe for you or someone you care about.
Causes Melancholic Depression?
It is not clear what causes negative, depressive symptoms. There is speculation that biological, psychological, and social elements play a role.
Biological factors: Changes in brain chemicals may cause melancholic depression. Genetic factors or other medical conditions could cause these changes.
Psychological factors: This could be due to negative thinking patterns, such as expecting the worst. Melancholy and depression may have more to do with one’s mind than their biology.
Social factors: Stressful life events or social isolation can all trigger negative, depressive symptoms.
These causes can be mutually incompatible. People suffering from this type of depression might have brain changes that cause their condition. However, psychological and social factors could also play a part.
Traumatic events: A melancholic episode may be triggered by trauma. While the sad depressive disorder is not thought to be caused by trauma, it can trigger it in someone with a genetic tendency.
Features of melancholic depression
People with melancholic characteristics tend to have a relatively normal childhood. If they do have problems, it is not common for them to have significant difficulties with their relationships and work performance.
These episodes can happen without apparent triggers and are more severe than one would expect, given the circumstances. Research from Queen’s University suggests that minor, not-severe stressors may also cause melancholic episodes. It may support the theory that inflammation plays a role in developing this particular form of depression.
Lundby Study, a longitudinal study conducted in a Swedish community, found that people who had the first episode of depression with melancholic characteristics were more likely to experience a recurrence than those with non-melancholic episodes.
Diagnosis Of Melancholic Depression
The DSM-5’s “melancholic features specifier” allows for the clustered description of symptoms characteristic of a major depressive episode in either major Depressive Illness or Bipolar Disorder. This symptom cluster comprises:
- Anhedonia is a near-total inability to feel pleasure
- Lack of positive reactions to typically pleasurable items
- A quality of mood that is distinct from grief/loss. It subjectively feels different
- Early morning awakening
- Psychomotor retardation is a slowing down of movement, thinking, or agitation.
- Significant loss of appetite
- Morning symptoms are more severe
- excessive/inappropriate guilt
Either symptoms 1 or 2 must be present. Symptom 5 psychomotor symptoms are almost always present. Meeting all the requirements for a major depressive disorder diagnosis would be ideal. Clinically substantial distress or deficits in occupational or social functioning are examples of such symptoms, as are those that have persisted for at least two weeks.
Although many people experience these symptoms during a major depression episode, melancholic features are the most common. Many possible combinations of symptoms can be present in major depressive episodes. Not everyone with major depressive episodes has the same features.
It is not clear whether melancholic or atypical depression is a distinct illness. It includes a group of symptoms such as increased sleep, appetite, mood reactivity, and pleasurable stimuli. The DSM categorical system considers them different symptoms of the same disease.
Both psychotherapy and medication use to treat melancholy depressive disorder. Because biological reasons often cause melancholic depression, medication is commonly used to treat it.
Psychotherapy can be used to change negative attitudes and habits or to develop better ways to cope with depressive episodes.
Psychotherapies and medicines are sometimes not as effective for some people. There are other options. Below are all the most common treatments for melancholia.
Although there is no evidence to link melancholic and major depressive disorders, the DSM-5 recognizes them as a feature or sign. Some researchers advocate that melancholic depressive disorder be reclassified as an entirely different disorder.
If you experience melancholy, it is essential to seek the help of a mental health professional or doctor. There are many treatment options for depression. These include medication, therapy, and other types of therapy.
1. Dold M, et. al, (2021). Melancholic features in major depression
2. Fink M, et. al, (2013). Melancholia: Restoration in psychiatric classification
3. Rapaport L, (2022). Modeling heterogeneous brain dynamics of depression