Melancholic depression

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Melancholic depression
Accademia - La Meditazione by Domenico Fetti 1618.jpg
Meditation by Domenico Fetti 1618
Specialty Psychiatry
Symptoms Low mood, low self-esteem, fatigue, insomnia, anorexia, anhedonia, lack of mood reactivity
Complications Self harm, suicide
Usual onsetEarly adulthood
Causes Genetic, environmental, and psychological factors
Risk factors Family history, trauma
Treatment Counseling, antidepressant medication, electroconvulsive therapy

Melancholic depression, or depression with melancholic features, is a DSM-IV and DSM-5 specifier of depressive disorders. The specifier is used to distinguish clinically relevant subsets of causes and symptoms [1] that have the potential to influence treatment.

Contents

Classification

Depression with melancholic features is classified under the fourth and fifth versions Diagnostic and Statistic Manual of Mental Disorders (DSM-IV and DSM-5) as a specifier of depressive disorders. [1] A specifier essentially is a subcategory of a disease, explaining specific features or symptoms that are added to the main diagnosis. [2]

According to the DSM-IV, the "melancholic features" specifier may be applied to the following only:

  1. Major depressive episode, single episode
  2. Major depressive episode, recurrent episode
  3. Bipolar I disorder, most recent episode depressed
  4. Bipolar II disorder, most recent episode depressed

It is important to note, however, that people who suffer from melancholic depression do not need to have melancholic features in every depressive episode. [3]

Signs and symptoms

Melancholic depression requires at least one of the following symptoms during the last depressive episode:

And at least three of the following:

Melancholic features apply to an episode of depression that occurs as part of either major depressive disorder, persistent depressive disorder (dysthymia), or bipolar disorder I or II. [4] They are more likely to occur in patients who suffer from depression with psychotic features. [1] People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech. [5]

Causes

The causes of melancholic depressive disorder are believed to be mostly biological factors that can be hereditary. Biological origins of the condition include problems with the HPA axis and sleep structure of patients. [6] MRI studies have indicated that melancholic depressed patients have issues with the connections between different regions of the brain, specifically the insula and fronto-parietal cortex. [7] Some studies have found that there are biological marker differences between patients with melancholic depression and other subtypes of depression. [8] Sometimes stressful situations can trigger episodes of melancholic depression, though this is a contributing cause rather than a necessary or sufficient cause. Moreover, people with psychotic symptoms are also thought to be more susceptible to this disorder. [9]

Physicians often do not notice the symptoms in patients of old age because they perceive the symptoms to be a part of dementia. Major depressive disorder, melancholic or otherwise, is a separate condition that can be comorbid, or occurring at the same time as dementia in the elderly. [10]

The research regarding melancholic depression consistently finds that men are more likely to receive a melancholic depression diagnosis. [11]

Treatment

Melancholic depression, due to some fundamental differences with standard clinical depression or other subtypes of depression, has specific types of treatments that work, and the success rates for different treatments can vary. [12] [6] Treatment can involve antidepressants and empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression. [13]

Melancholic depression is often considered to be a biologically based and particularly severe form of depression. Therefore, the treatments for this specifier of depression are more biomedical and less psychosocial (which would include talk therapy and social support). [14] The general initial or "ideal" treatment for melancholic depression is antidepressant medication, and psychotherapy is added later on as support if at all. [15] The scientific support for medication as the best treatment is that patients with melancholic depression are less likely to improve with placebos, unlike other depression patients. This indicates the improvements observed after medication actually come from the biological basis of the condition and the treatment. [6] There are several types of antidepressants that can be prescribed including SSRIs, SNRIs, tricyclic antidepressants, and MAOIs; the antidepressants tend to vary on how they work and what specific chemical messengers in the brain they target. [16] SNRIs are generally more effective than SSRIs because they target more than one chemical messenger (serotonin and norepinephrine). [11]

Although psychotherapy treatments can be used such as talk therapy and cognitive behavioral therapy (CBT), they have shown to be less effective than medication. [6] In a randomized clinical trial, it was shown that CBT was less effective than medication in treating symptoms of melancholic depression after 12 weeks. [17]

Electroconvulsive therapy (ECT) was previously believed to be an effective treatment for melancholic depression. [18] ECT has been more commonly used for patients with melancholic depression due to the severity. In 2010, a study found that 60% of depression patients treated with ECT had melancholic symptoms. [19] However, studies since the 2000s have failed to demonstrate positive treatment results from ECT, although studies also indicate a more positive response to ECT in melancholic patients than other depressed patients. [6] [20]

It has been observed in studies that patients with melancholic depression tend to recover less often than other types of depression. [11]

Frequency

The prevalence of having the melancholic depression specifier among patients diagnosed with clinical depression is estimated to be about 25% to 30%. [21]

The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low. [22]

See also

Related Research Articles

<span class="mw-page-title-main">Bipolar disorder</span> Mental disorder that causes periods of depression and abnormally elevated mood

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.

Bipolar I disorder is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features. Most people also, at other times, have one or more depressive episodes.

<span class="mw-page-title-main">Major depressive disorder</span> Mental disorder involving persistent low mood, low self-esteem, and loss of interest

Major depressive disorder (MDD), also known as clinical depression, is a mental disorder characterized by at least two weeks of pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Introduced by a group of US clinicians in the mid-1970s, the term was adopted by the American Psychiatric Association for this symptom cluster under mood disorders in the 1980 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and has become widely used since.

<span class="mw-page-title-main">Mood disorder</span> Mental disorder affecting the mood of an individual, over a long period of time

A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD).

Schizoaffective disorder is a mental disorder characterized by abnormal thought processes and an unstable mood. This diagnosis requires symptoms of both schizophrenia and a mood disorder: either bipolar disorder or depression. The main criterion is the presence of psychotic symptoms for at least two weeks without any mood symptoms. Schizoaffective disorder can often be misdiagnosed when the correct diagnosis may be psychotic depression, bipolar I disorder, schizophreniform disorder, or schizophrenia. This is a problem as treatment and prognosis differ greatly for most of these diagnoses.

<span class="mw-page-title-main">Depression (mood)</span> State of low mood and aversion to activity

Depression is a mental state of low mood and aversion to activity. It affects more than 280 million people of all ages. Depression affects a person's thoughts, behavior, feelings, and sense of well-being. Depressed people often experience loss of motivation or interest in, or reduced pleasure or joy from, experiences that would normally bring them pleasure or joy. Depressed mood is a symptom of some mood disorders such as major depressive disorder and dysthymia; it is a normal temporary reaction to life events, such as the loss of a loved one; and it is also a symptom of some physical diseases and a side effect of some drugs and medical treatments. It may feature sadness, difficulty in thinking and concentration and a significant increase or decrease in appetite and time spent sleeping. People experiencing depression may have feelings of dejection or hopelessness and may experience suicidal thoughts. It can either be short term or long term.

Dysthymia, also known as persistent depressive disorder (PDD), is a mental and behavioral disorder, specifically a disorder primarily of mood, consisting of similar cognitive and physical problems as major depressive disorder, but with longer-lasting symptoms. The concept was used by Robert Spitzer as a replacement for the term "depressive personality" in the late 1970s.

Atypical depression is defined in the DSM IV as depression that shares many of the typical symptoms of major depressive disorder or dysthymia but is characterized by improved mood in response to positive events. In contrast to those with atypical depression, people with melancholic depression generally do not experience an improved mood in response to normally pleasurable events. Atypical depression also often features significant weight gain or an increased appetite, hypersomnia, a heavy sensation in the limbs, and interpersonal rejection sensitivity that results in significant social or occupational impairment.

<span class="mw-page-title-main">Psychotic depression</span> Medical condition

Psychotic depression, also known as depressive psychosis, is a major depressive episode that is accompanied by psychotic symptoms. It can occur in the context of bipolar disorder or major depressive disorder. It can be difficult to distinguish from schizoaffective disorder, a diagnosis that requires the presence of psychotic symptoms for at least two weeks without any mood symptoms present. Unipolar psychotic depression requires that psychotic symptoms occur during severe depressive episodes, although residual psychotic symptoms may also be present in between episodes. Diagnosis using the DSM-5 involves meeting the criteria for a major depressive episode, along with the criteria for "mood-congruent or mood-incongruent psychotic features" specifier.

A major depressive episode (MDE) is a period characterized by symptoms of major depressive disorder. Those affected primarily exhibit a depressive mood for at least two weeks or more, and a loss of interest or pleasure in everyday activities. Other symptoms can include feelings of emptiness, hopelessness, anxiety, worthlessness, guilt, irritability, changes in appetite, difficulties in concentration, difficulties remembering details, making decisions, and thoughts of suicide. Insomnia or hypersomnia and aches, pains, or digestive problems that are resistant to treatment may also be present.

Depressive Disorder Not Otherwise Specified (DD-NOS) is designated by the code 311 in the DSM-IV for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses "any depressive disorder that does not meet the criteria for a specific disorder." In the DSM-5, it is called unspecified depressive disorder.

Bipolar II disorder (BP-II) is a mood disorder on the bipolar spectrum, characterized by at least one episode of hypomania and at least one episode of major depression. Diagnosis for BP-II requires that the individual must never have experienced a full manic episode. Otherwise, one manic episode meets the criteria for bipolar I disorder (BP-I).

Pseudodementia is a condition where mental cognition can be temporarily decreased. The term pseudodementia is applied to the range of functional psychiatric conditions such as depression, schizophrenia and hysteria that may mimic organic dementia, but are essentially reversible on treatment. Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attentional control and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed. People with pseudodementia are typically very distressed about the cognitive impairment they experience. Two treatments found to be effective for the treatment of depression may also be beneficial in the treatment of pseudodementia: Cognitive behavioral therapy (CBT) which identifies behaviors that positively and negatively impact mood, and Interpersonal therapy which focuses on identifying ways in which interpersonal relationships contribute to depression.

Endogenous depression(melancholia) is an atypical subclass of major depressive disorder. It could be caused by genetic and biological factors. Endogenous depression occurs due to the presence of an internal stressor instead of an external stressor. Endogenous depression includes patients with treatment-resistant, non-psychotic, major depressive disorder, characterized by abnormal behavior of the endogenous opioid system but not the monoaminergic system. Symptoms vary in severity, type, and frequency and can be attributed to cognitive, social, biological, or environmental factors that result in persistent feelings of sadness and distress. Since symptoms are due to a biological phenomenon, prevalence rates tend to be higher in older adults. Due to this fact, biological-focused treatment plans are often used in therapy to ensure the best prognosis.

Minor depressive disorder, also known as minor depression, is a mood disorder that does not meet the full criteria for major depressive disorder but at least two depressive symptoms are present for a long time. These symptoms can be seen in many different psychiatric and mental disorders, which can lead to more specific diagnoses of an individual's condition. However, some of the situations might not fall under specific categories listed in the Diagnostic and Statistical Manual of Mental Disorders. Minor depressive disorder is an example of one of these nonspecific diagnoses, as it is a disorder classified in the DSM-IV-TR under the category Depressive Disorder Not Otherwise Specified (DD-NOS). The classification of NOS depressive disorders is up for debate. Minor depressive disorder as a term was never an officially accepted term, but was listed in Appendix B of the DSM-IV-TR. This is the only version of the DSM that contains the term, as the prior versions and the most recent edition, DSM-5, does not mention it.

Management of depression is the treatment of depression that may involve a number of different therapies: medications, behavior therapy, psychotherapy, and medical devices.

What was previously known as melancholia and is now known as clinical depression, major depression, or simply depression and commonly referred to as major depressive disorder by many health care professionals, has a long history, with similar conditions being described at least as far back as classical times.

<span class="mw-page-title-main">Depression in childhood and adolescence</span> Pediatric depressive disorders

Major depressive disorder, often simply referred to as depression, is a mental disorder characterized by prolonged unhappiness or irritability. It is accompanied by a constellation of somatic and cognitive signs and symptoms such as fatigue, apathy, sleep problems, loss of appetite, loss of engagement, low self-regard/worthlessness, difficulty concentrating or indecisiveness, or recurrent thoughts of death or suicide.

Late-life depression refers to depression occurring in older adults and has diverse presentations, including as a recurrence of early-onset depression, a new diagnosis of late-onset depression, and a mood disorder resulting from a separate medical condition, substance use, or medication regimen. Research regarding late-life depression often focuses on late-onset depression, which is defined as a major depressive episode occurring for the first time in an older person.

Cyclothymia, also known as cyclothymic disorder, psychothemia / psychothymia, bipolar III, affective personality disorder and cyclothymic personality disorder, is a mental and behavioural disorder that involves numerous periods of symptoms of depression and periods of symptoms of elevated mood. These symptoms, however, are not sufficient to indicate a major depressive episode or a manic episode. Symptoms must last for more than one year in children and two years in adults.

References

  1. 1 2 3 American Psychiatric Association (2013-05-22). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN   978-0-89042-555-8.
  2. ↑ "What's the DSM-5?". Psych Central. 2017-05-17. Retrieved 2023-03-28.
  3. ↑ "The Darkest Mood: Major Depression With Melancholic Features | Psychology Today". www.psychologytoday.com. Retrieved 2023-03-28.
  4. ↑ Diagnostic and Statistical Manual of Mental Disorders. Arlington VA: American Psychiatric Publishing. 2013. ISBN   978-0-89042-559-6.
  5. ↑ "Melancholic Depression: Symptoms, Diagnosis, Treatment, and Coping Tips". Psych Central. 2022-11-03. Retrieved 2023-03-28.
  6. 1 2 3 4 5 Parker, Gordon (6 September 2015). "Back to black: why melancholia must be understood as distinct from depression". The Conversation. Retrieved 2023-03-28.
  7. ↑ Gordon Parker, M. D. (2017-01-20). "An Update on Melancholia". Vol 34 No 1. 34.{{cite journal}}: Cite journal requires |journal= (help)
  8. ↑ Spanemberg, Lucas; Caldieraro, Marco Antonio; Vares, Edgar Arrua; Wollenhaupt-Aguiar, Bianca; Kauer-Sant'Anna, Márcia; Kawamoto, Sheila Yuri; Galvão, Emily; Parker, Gordon; Fleck, Marcelo P. (2014-08-19). "Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure". Neuropsychiatric Disease and Treatment. 10: 1523–1531. doi: 10.2147/NDT.S66504 . PMC   4149384 . PMID   25187716.
  9. ↑ "Melancholic Depression: Causes, Symptoms, and Treatment | Clinical Depression: Symptoms and Treatment". Melancholic Depression. Retrieved 2023-03-28.
  10. ↑ Pekker, Michael. "Clinical Depression: Symptoms and Treatments" . Retrieved 12 October 2011.
  11. 1 2 3 Gili, Margalida; Roca, Miquel; Armengol, Silvia; Asensio, David; Garcia-Campayo, Javier; Parker, Gordon (2012-10-26). "Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions". PLOS ONE. 7 (10): e48200. Bibcode:2012PLoSO...748200G. doi: 10.1371/journal.pone.0048200 . ISSN   1932-6203. PMC   3482206 . PMID   23110213.
  12. ↑ "What is melancholic depression? Symptoms, diagnosis, and more". www.medicalnewstoday.com. 2022-05-30. Retrieved 2023-03-28.
  13. ↑ Luty, Suzanne; Carter, Janet; McKenzie, Janice (2007). "Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression". The British Journal of Psychiatry. 190 (6): 496–502. doi: 10.1192/bjp.bp.106.024729 . PMID   17541109.
  14. ↑ McGrath, Patrick; Ashan Khan; Madhukar Trivedi; Jonathan Stewart; David W Morris; Stephen Wisniewski; Sachiko Miyahara; Andrew Nierenberg; Maurizio Fava; John Rush (2008). "Response to a Selective Serotonin Reuptake Inhibitor (Citalopram) in Major Depressive Disorder with Melancholic Features: A STAR*D Report". Journal of Clinical Psychiatry. 69 (12): 1847–1855. doi:10.4088/jcp.v69n1201. PMID   19026268.
  15. ↑ "The Darkest Mood: Major Depression With Melancholic Features | Psychology Today". www.psychologytoday.com. Retrieved 2023-03-28.
  16. ↑ "Melancholic Depression: Symptoms, Diagnosis, Treatment, and Coping Tips". Psych Central. 2022-11-03. Retrieved 2023-03-28.
  17. ↑ Gilfillan, David; Parker, Gordon; Sheppard, Elizabeth; Manicavasagar, Vijaya; Paterson, Amelia; Blanch, Bianca; McCraw, Stacey (2014-05-01). "Is cognitive behaviour therapy of benefit for melancholic depression?". Comprehensive Psychiatry. 55 (4): 856–860. doi:10.1016/j.comppsych.2013.12.017. ISSN   0010-440X. PMID   24461162.
  18. ↑ Rasmussen, Keith G. (December 2011). "Electroconvulsive Therapy and Melancholia: Review of the Literature and Suggestions for Further Study". The Journal of ECT. 27 (4): 315–322. doi:10.1097/YCT.0b013e31820a9482. ISSN   1095-0680. PMID   21673591.
  19. ↑ "The Darkest Mood: Major Depression With Melancholic Features | Psychology Today". www.psychologytoday.com. Retrieved 2023-03-28.
  20. ↑ Rush, Gavin; O’Donovan, Aoife; Nagle, Laura; Conway, Catherine; McCrohan, AnnMaria; O’Farrelly, Cliona; Lucey, James V.; Malone, Kevin M. (2016-11-15). "Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy". Journal of Affective Disorders. 205: 60–68. doi:10.1016/j.jad.2016.06.035. ISSN   0165-0327. PMC   5291160 . PMID   27414954.
  21. ↑ "The Darkest Mood: Major Depression With Melancholic Features | Psychology Today". www.psychologytoday.com. Retrieved 2023-03-28.
  22. ↑ Radua, Joaquim; Pertusa, Alberto; Cardoner, Narcis (28 February 2010). "Climatic relationships with specific clinical subtypes of depression". Psychiatry Research. 175 (3): 217–220. doi:10.1016/j.psychres.2008.10.025. PMID   20045197. S2CID   21764662.
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