Table of ContentsView AllTable of ContentsHistory of Melancholic DepressionSymptomsCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
History of Melancholic Depression
Symptoms
Causes
Diagnosis
Treatment
Coping
Close
In the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR), 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).
Research has found that people with melancholic depression have a higher risk for unemployment, psychotic features, inpatient treatment, and suicide risk than people with non-melancholic depression.
At a GlanceMelancholic depression, also sometimes known as melancholia, is a severe form of major depressive disorder. People experience a complete loss of pleasure, a slowing down of activity, and feelings of profound despair. Trauma, family history, and brain chemistry can contribute to its onset, but melancholic depression is strongly tied to genetic causes. Antidepressant medications are the first-line treatment for melancholic depression.
At a Glance
Melancholic depression, also sometimes known as melancholia, is a severe form of major depressive disorder. People experience a complete loss of pleasure, a slowing down of activity, and feelings of profound despair. Trauma, family history, and brain chemistry can contribute to its onset, but melancholic depression is strongly tied to genetic causes. Antidepressant medications are the first-line treatment for melancholic depression.
While melancholic depression is no longer considered a separate, distinct diagnosis, some researchers suggest that it should be considered a distinct syndrome 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. It means “black bile” in Greek. The translation is fitting because Hippocrates believed that an excess of black bile (one bodily fluid out of the “Four Humours,” as he called them) caused melancholia.
The symptoms Hippocrates categorized under melancholia are nearly identical to the symptoms we use today for melancholic depression, including fear, not wanting to eat, insomnia, restlessness, agitation, and sadness.
The History of Depression
Symptoms of Melancholic Depression
Symptoms of melancholic depression include:
What Causes Melancholic Depression?
Older people, inpatients, and those who exhibitpsychotic featuresare at greater risk for melancholic depression.
The exactcauses of depressionare not clear, butgenetics,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.
What Is the Chemistry Behind Depression?
How Melancholic Depression Is Diagnosed
A doctor will start with an evaluation to assess the nature, severity, and duration of your symptoms. Some of the questions they may ask include:
A 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.
Symptoms of Major Depressive Disorder
In order to be diagnosed with melancholic depression, an individual must exhibit symptoms of major depressive disorder such as:
Symptoms of Melancholia
To be diagnosed with melancholic features, you must have at least three of these symptoms:
Related Conditions
A doctor will also rule out other conditions, including:
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.
If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.
For more mental health resources, see ourNational Helpline Database.
Should You See a Doctor, Psychiatrist, or Therapist for Depression?
Treatments for Melancholic Depression
Types of antidepressants that may be used for melancholic depression include:
Selective Serotonin Reuptake Inhibitors (SSRIs)
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs affect the way bothserotoninandnorepinephrinework in the brain. Common kinds areCymbalta(duloxetine) andEffexor(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 that seem to improve mood. Examples of medicines in this category areRemeron(mirtazapine), Oleptro (trazodone), Trintellix (vortioxetine), andViibryd(vilazodone).
Tricyclic Antidepressants (TCAs)
These are first-generation antidepressants and may have more side effects than newer versions. This 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.
Major Depressive Disorder Treatment Effects
Coping With Melancholic Depression
If you suspect that you have melancholic symptoms, you should talk to a 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:
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 a doctor to decide if this is a good option to complement your other treatments.
Best Online Depression Resources
Takeaway
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 a doctor who can rule out other causes and recommend treatment options that can help you regain balance.
10 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022.
Monzón S, Gili M, Vives M, et al.Melancholic versus non-melancholic depression: differences on cognitive function. A longitudinal study protocol.BMC Psychiatry. 2010;10:48. doi:10.1186/1471-244X-10-48
Hyett MP, Parker GB, Guo CC, et al.Scene unseen: Disrupted neuronal adaptation in melancholia during emotional film viewing.Neuroimage Clin. 2015;9:660-667. doi:10.1016/j.nicl.2015.10.011
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Parker G, Fink M, Shorter E, et al.Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder.AJP.2010;167(7):745-747. doi:10.1176/appi.ajp.2010.09101525
Searle A, Calnan M, Lewis G, Campbell J, Taylor A, Turner K.Patients' views of physical activity as treatment for depression: a qualitative study.Br J Gen Pract. 2011;61(585):149-156. doi:10.3399/bjgp11X567054
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