Melancholic Depression Symptoms, Diagnosis, and Treatment

Melancholic Depression Symptoms, Diagnosis, and Treatment Bipolar Disorder Symptoms Depression Print An Overview of Melancholic Depression By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial policy Marcia Purse Medically reviewed by Medically reviewed by Steven Gans, MD on January 08, 2015 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 24, 2020 Depression Overview Types Symptoms Causes & Risk Factors Diagnosis Treatment Coping ADA & Your Rights Depression in Kids Eric Audras/ Getty Images 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 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 of what he labeled The Four ?Humours, caused melancholia. The symptoms he categorized under melancholia are nearly identical to the symptoms we use today, 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 emptinessDepression is consistently worse in the morningEarly morning waking of at least two hours earlier than normalPsychomotor disturbances of either retardation, the slowing of normal movement, or agitation, increased and/or irregular movementAnorexia or weight lossExcessive or inappropriate guilt Symptoms of Clinical Depression Causes   The start of these episodes is usually not caused by a specific event. Even when something good happens, the individuals 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.?? Causes and Risk Factors of Depression Diagnosis Your doctor will start with an evaluation to assess the nature, severity, and duration of your symptoms. Some of the questions your doctor 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? Your 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:?? Feelings of persistent sadnessLoss of interest and pleasureLow energy or fatigueIrritabilityAppetite changesSleep difficultiesChanges in activity levelsDifficulty concentratingThoughts of dying or suicide To be diagnosed with melancholic features, you must have at least three of these symptoms: Depression that is different from griefWeight loss or loss of appetiteSlowed activity or restlessnessExcessive guiltWaking much earlier than normalMore severe depressive symptoms in the morning Your doctor will also rule out other conditions. Other issues that may be considered include: Bipolar disorderCyclothymic disorderPersistent depressive disorderDisruptive mood dysregulation disorderPremenstrual dysphoric disorderDepression caused by illicit drugs, prescribed medications, or some physical illness What to Expect When Seeing a Doctor for Depression 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 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: Selective serotonin reuptake inhibitors (SSRIs):  These medications work by changing the way the neurotransmitter serotonin works in the brain thereby improving mood. Common types include Prozac (fluoxetine), Paxil (paroxetine), Zoloft (sertraline), and Lexapro (escitalopram).Serotonin-norepinephrine reuptake inhibitors (SNRIs):  SNRIs affect the way both serotonin and norepinephrine work in the brain. Common kinds are Cymbalta (duloxetine) and Effexor (venlafaxine).Norepinephrine and dopamine reuptake inhibitors (NDRIs):  Wellbutrin (bupropion) is the only medication in this class that affects norepinephrine and dopamine.Atypical antidepressants:  These medications affect brain chemicals which seem to improve mood. Examples of medicines in this category are Remeron (mirtazapine), Oleptro (trazodone), Brintellix (vortioxetine), and Viibryd (vilazodone).Tricyclic antidepressants (TCAs):  These are first-generation antidepressants and may have more side effects than newer versions. Thi s class includes Tofranil (imipramine), Pamelor (nortriptyline), and  amitriptyline.Monoamine oxidase inhibitors (MAOIs):  This is another older class of antidepressants that can have serious side effects but may be a good option for certain people. The main medications in this class are Parnate (tranylcypromine), Nardil (phenelzine), and Marplan (isocarboxazid). 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 your 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:?? Getting regular exerciseSpending time with friends and loved onesEating a healthy dietMeditationFollowing a consistent sleep schedule 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 your doctor to decide if this is a good option to complement your other treatments. 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. Best Online Depression Resources 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 your doctor who can rule out other causes and recommend treatment options that can help you regain balance.