In this series, I dig a little deeper into the meaning of psychological terms. This week’s term is melancholic depression (melancholia).
The word melancholia comes from the Greek for black bile, part of the ancient four humours medical belief system. In the 5th century BCE, Hippocrates first identified melancholia as a disease with various mental and physical symptoms. In the 16th and 17th centuries, the idea of a melancholic temperament became fashionable in English art and literature.
In the present day, melancholia is a specifier for a type of major depressive episode (which can occur in the context of multiple diagnoses, including major depressive disorder and bipolar disorder). Some researchers have argued that it warrants its own diagnosis, but the committee formulating the DSM-5 wasn’t convinced that it was a distinct disorder.
In the DSM-5, melancholic features specifies a subtype of major depressive episode. Melancholic symptoms include:
- anhedonia (inability to feel pleasure)
- lack of positive reaction to normally pleasurable things
- a quality of mood that’s distinct from grief/loss
- early morning awakening
- psychomotor retardation (slowed movement and thinking)
- significant loss of appetite
- symptoms that are worse in the morning
Characteristics of melancholic depression
People with melancholic depression tend to have normal levels of developmental stressors and no significant problems with relationships or work when they’re not depressed. Melancholic depressive episodes are more likely to happen without any identifiable triggers, and people are more likely to identify their depression as an imposed disease rather than a logical reaction to life stressors.
Melancholic depression is thought to caused mostly by biological factors. It’s associated with an increased likelihood of family history of mood disorder. It’s also associated with higher severity depressive episodes, including psychotic depression and suicidality.
Response to treatment
Individuals with melancholic depression don’t tend to respond well to SSRIs, and respond better to antidepressants that target the neurotransmitter norepinephrine. MAOIs (monoamine oxidase inhibitors) tend to be the most effective antidepressant in this population. The addition of a psychostimulant (like an ADHD medication) may be helpful.
My most recent psychiatrist thought I had melancholic depression. I don’t have all the symptoms now, but the prominent anhedonia definitely matches. The types of meds I’ve responded best to also matches. I suppose it really doesn’t make that much of a difference, though; everyone’s illness is unique, regardless of subtype.
Does melancholic depression sound like something you may have experienced?
You can find the rest of the what is… series in the Psychology Corner.