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What Is Melancholic Depression?

Medically Reviewed by Jennifer Casarella, MD on July 14, 2021

Melancholic depression is a type of depression that’s also called melancholia. As many as 15%-30% of people with depression have this type.

Melancholic depression may have more severe symptoms than other types of depression. It may also be harder to treat than other types of depression. But you can learn to manage your symptoms with the help of a mental health professional.

Symptoms

Melancholic depression is more likely to cause physical symptoms, not just feeling blue or tearful. You may have no energy. You feel empty and unable to feel happiness. Your movements and thoughts may slow down.

The two main symptoms are:

  • You’ve lost the ability to enjoy activities in your life.
  • You can’t respond to pleasure in a positive way.

Melancholic depression is also characterized by:

  • Poor-quality sleep from waking up too early
  • Loss of appetite or weight loss
  • Trouble with concentration or memory
  • Feeling empty or unresponsive
  • Excessive guilt
  • Feelings of hopelessness
  • Thoughts of suicide

Psychomotor signs. If you have melancholic depression, your behaviors may change. Examples include:

  • Speech changes, or talking at different volumes or pausing when you speak
  • Eye movements like a fixed gaze or not making eye contact when you talk with people
  • Slowed movement of your head, limbs, or torso
  • Slouched posture
  • Touching your face or body often

Body aches. Some research shows that about 70% of people with melancholic depression can also have musculoskeletal pain.

Who’s at risk?

Melancholic depression symptoms usually happen later in life. This type of depression tends to run in families. People in your family tree may have had mood problems or even died by suicide.

Melancholic depression symptoms may be worse at times of the year when there is less sunlight, when the days are shorter, or when it’s cold outside.

People who have postpartum depression, or depression soon after giving birth, may also experience melancholic symptoms.

Causes

Changes in your brain and hormonal pathways can contribute to melancholic depression. The hypothalamus, the pituitary gland, and adrenal glands may not be functioning correctly. This pathway is called the hypothalamic-pituitary-adrenal (HPA) axis. These glands release chemicals that regulate stress and appetite.

With melancholic depression, you may have high levels of cortisol, a steroid hormone that’s made by your adrenal glands when you’re in stress. Your HPA axis regulates it. This affects many different functions in your body, including your appetite, metabolism, and memory.

You may also have changes in brain signals called neurons. These signals affect how you respond to your surroundings.

Diagnosis

Your doctor or a mental health professional will diagnose your depression based on your signs and symptoms.

You must have one or both of the two main symptoms of melancholic depression: loss of the ability to enjoy life or to respond to pleasurable activities in life.

You must also have at least three of these symptoms:

  • Despair not due to grief or loss of a loved one
  • Loss of appetite or significant weight loss
  • Psychomotor changes
  • Depressed mood that’s worse in the morning than at night
  • Waking up at least 2 hours earlier than you wanted
  • Strong feelings of guilt

Treatment

Melancholic depression treatments may include a combination of medications and therapy.

Antidepressants. Doctors often prescribe tricyclic antidepressants (TCAs) for melancholic depression, although they may also use other antidepressants and medications. TCAs include these medications:

Electroconvulsive therapy. If your other treatments don’t work, your doctor may suggest electroconvulsive therapy (ECT) to relieve your symptoms. While you’re under general anesthesia, a technician sends electrical signals to your brain. This causes you to have brief seizures. ECT may change your brain chemical balance to relieve depression symptoms.

Psychotherapy. Psychotherapy, or talk therapy, isn’t always as helpful for treating melancholic depression as other types of depression. Even after treatment, your symptoms may come back again later, but it’s possible to manage your depression with the help of your doctor and mental health professionals.

WebMD Medical Reference

Sources

SOURCES:

HealthDirect Australia: “Melancholia (Depression with melancholic features).”

PLoS One: “Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical, and Non-Melancholic Depressions.”

Good Therapy: “Melancholia.”

BMC Psychiatry: “Melancholic versus non-melancholic depression: differences on cognitive function, a longitudinal study protocol.”

Progress in Neuro-Psychopharmacology and Biological Psychiatry: “Psychomotor retardation in depression: Biological underpinnings, measurement, and treatment.”

Pain Medicine: “Musculoskeletal Pain in Melancholic and Atypical Depression.”

Lee H.Y. and Kim Y.K. Major Depressive Disorder: Cognitive and Neurobiological Mechanisms: Different Mechanisms Between Melancholic and Atypical Depression, Intech Open, 2015.

Hormone Health Network: “What Is Cortisol?”

Mayo Clinic: “Tricyclic antidepressants and tetracyclic antidepressants,” “Electroconvulsive therapy (ECT).”

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