Melancholic Depression: Symptoms, Diagnosis and Treatment

Melancholic Depression

What is melancholic depression?

Melancholic depression is a type of major depression with melancholy characteristics. Formerly recognized as a separate mental illness, melancholic depression is no longer identified as such by the American Psychiatric Association (APA). Now, melancholia is considered a subtype of major depressive disorder – a type of depression that is distinct from other forms of depression.

MDD is defined by an intense feeling of sadness and hopelessness over a sustained period of time. Many aspects of life, such as work, school and relationships, can be affected by the disorder.

A variety of physical functions, such as sleep and appetite, may also be affected, as well as mood and behavior. The symptoms of MDD lead to people losing interest in activities they used to enjoy and having trouble getting through the day. It is also possible for them to feel like life isn’t worth living from time to time.

Symptoms of MDD are both different in severity and type depending on the individual. Many people experiencing MDD develop additional symptoms, including melancholia and catatonia. Medications and talk therapy are usually sufficient to manage many symptoms.

Read: Situational Depression

Melancholy vs. depression

In the United States, 30.2% of adults suffer from depressive symptoms, according to the Centers for Disease Control and Prevention (CDC). People with this mood disorder experience persistent low moods that hamper their ability to perform daily activities like sleeping, eating, and working. A person’s menstrual cycle, life events, seasonal changes, or a change in their mood can all cause depression.

There is a consensus among researchers that 25–30% of people with depression suffer from melancholic depression. Melancholia may also be linked to unique brain changes not seen with other forms of depression, according to research from 2015. There is a reduced connection between the frontoparietal cortex and the insula in the above research, for instance.

An overview of the structure and function of the insula published in 2017 noted that it regulates mood, sensorimotor responses, and empathy.

Cortex frontoparietal helps control behavioral patterns and cognitive processes.

The brain regions associated with nonreactive mood are reduced in connectivity in people with melancholic depression who watch emotionally charged films. Nonmelancholic depression participants showed increased connectivity, contrary to participants with melancholic depression.

According to the above 2012 article, depression has traditionally been treated with rest, talk therapy, amphetamines, meprobamate, and benzodiazepines. Antidepressants are commonly prescribed to treat depression. Melancholia is treated by somatic therapies, electroconvulsive therapy (ECT), and tricyclic antidepressants.

Melancholic depression represents a subtype of severe clinical depression, but research has yet to confirm the distinct nature of the condition. This is currently considered a symptom of severe depression by official diagnostic guidelines.

Symptoms of melancholic depression

Melancholic depression can manifest in people with symptoms such as:

  • Feeling depressed for long periods of time
  • Reducing interest in previously pleasant activities
  • Lack of energy or fatigue
  • Anxiety or irritability
  • Overeating or undereating
  • Insufficient sleep
  • Movement changes in the body (e.g., jiggling your leg when you did not before)
  • Inability to concentrate, make decisions or remember thing.
  • Suicidal thoughts or feelings
  • Suicide attempt

Additionally, MDD sufferers may experience melancholic symptoms, such as:

  • Lack of enjoyment in daily activities
  • Inability to react to good news
  • Depressive and hopeless feelings
  • Sleep disruptions
  • Significant weight loss
  • Feelings of excessive guilt
  • Daytime symptoms of MDD

Those who frequently suffer from severe symptoms of MDD are more likely to exhibit melancholic features. These symptoms are also more common in people with MDD and psychosis.

Read: Teen Depression

Diagnosing melancholic depression

There are no longer distinct types of melancholic depression in the APA, and it is now grouped under MDD. Whenever a person has both depression and melancholy, the diagnosis is “major depressive disorder with melancholia.” To make this diagnosis, a physician will ask some of the following questions:

  • Can you get out of bed and start your day easily?
  • How about your symptoms in the mornings?
  • Do you sleep well?
  • Has your sleep pattern changed?
  • Describe a typical day in your life.
  • Are you following the same routine every day?
  • Do you still enjoy the same activities?
  • How do you improve your mood?
  • Do you find it harder to concentrate than before?

Also Readout: Endogenous Depression

Treatments for melancholic depression

A newer type of antidepressant may be used to treat MDD, such as selective serotonin reuptake inhibitors (SSRIs). There are well-known medications such as Prozac (fluoxetine), Celexa (citalopram) and Paxil (paroxetine).

There is evidence that some patients with MDD who have melancholic characteristics may respond better to older antidepressants, such as tricyclic antidepressants. They may also benefit from monoamine oxidase inhibitors (MAOIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine.

They increase the brain’s concentration of “feel good” chemicals like serotonin and norepinephrine by inhibiting their breakdown. It is sometimes possible to augment the effects of antidepressants with certain atypical antipsychotics, such as Abilify (aripiprazole).

People with MDD with melancholic characteristics are often treated with talk therapy in addition to medication. Combining these two methods of treatment typically yields greater results than either method alone.

Regular meetings with a therapist are needed for discussing symptoms and issues. They can teach you how to:

  • Adapt to stress or a crisis
  • Make positive changes to your beliefs and behaviors
  • Communicate more effectively
  • Deal with challenges effectively
  • Improve self-esteem
  • Feel more in control of life

Similar to individual therapy, group therapy allows you to share feelings with others who are able to relate.

A quick solution to MDD with melancholic features is electroconvulsive therapy (ECT). An electrode is attached to the head in order to trigger a mild seizure by sending electrical impulses to the brain.

Mental illnesses and mood disorders are now considered safe and effective when treated with ECT, but it still carries a stigma. Therefore, it is not recommended as a primary treatment for melancholy. The best treatment for MDD with melancholic features may be a combination of medication, talk therapy and ECT.

Related: How to Overcome Depression


It can cause major disruptions in how an individual is able to function in many areas of their lives since melancholic depression is characterized by tremendous sadness, loss of pleasure, and disinterest in daily activities.

It is important to speak with your doctor if you suspect that you are experiencing melancholic symptoms. One of the most effective treatments for this condition is antidepressants1. You can, however, do other things to manage your symptoms.

You can improve your mood by modifying your lifestyle in the following ways:

  • Exercise regularly
  • Friendships and family time
  • a healthy diet
  • Meditation
  • Sleeping on a regular schedule

These are all important things to remember, but melancholy depression’s symptoms can make them difficult. Your medication may take effect sooner than you expected, so you may be able to incorporate some of these changes more easily.

Managing your symptoms of melancholic depression may also be easier with online resources and support groups. Make sure you consult a doctor in order to determine whether this is a good complement to the other treatments you’re currently receiving.

Suicide prevention

You should act immediately if you think someone is at immediate risk of harming themselves or others:

  • Dial 911 or the local emergency number right away.
  • Make sure they have enough time to call for help before helping them.
  • Do not leave guns, knives, medications, or other items in the room.
  • Listen without judging, arguing, threatening or yelling.

Seek help from a crisis hotline or suicide prevention organization if you think someone is considering suicide. For more information, please call the National Suicide Prevention Lifeline: 800-273-8255.

Contact: Mental Help Resources


There is no evidence linking melancholic depression with major depressive disorder, but the DSM-5 recognizes it as a feature or symptom. There are some researchers, however, who advocate reclassifying melancholic depression as an entirely separate disorder.

People who experience melancholy as part of depression should seek help from a doctor or mental health professional. A variety of treatment options are available for depression, including medication, therapy, and other types of therapy.

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