Melancholic Depression: Causes, Symptoms, and Treatment

Melancholic depression, or 'depression with melancholic features' is a subtype of major depression characterized by the inability to find pleasure in positive things combined with physical agitation, insomnia, or decreased appetite.

Causes of Melancholia

Not much is known about the causes of melancholia; however, it is believed that it is mostly due to biological causes. Some may also have inherited this disorder from their parents. It is not caused by life events, although stressful circumstances can trigger an episode.

In psychoanalysis, Hanna Seagal describes melancholic depression as a defense mechanism devised by the body to fight the depressive state of the mind. This defense is known as manic-schizoid. Freud was the first person to use melancholic to describe depression. There are several symptoms with which we can identify this disorder in a person.

It has also been found that melancholia is quite common in individuals with bipolar depression I. It may also be present in bipolar depression II with features of psychomotor agitation.

Studies have also found that melancholia is quite common in an inpatient setting. Individuals with psychotic features are also believed to be more prone to this disorder.

It is quite common in old age where it often presents itself with psychotic symptoms. Often, it is missed by physicians and its symptoms are considered as just part of dementia. However, it may also be present along with dementia in the elderly.

Symptoms of Melancholic depression

Melancholic Depression is a type of major depression that tends to be diagnosed more often in older individuals, and appears to affect men and women equally. According to the "Diagnostic and Statistical Manual of Mental Disorders," there are eight symptoms that make up the diagnostic criteria for melancholic depression, four of which need to be met to diagnose melancholic depression.

  1. Loss of Pleasure
A person must report or exhibit a loss of interest or pleasure in almost all activities. For example, a person may have loved to go camping, but he no longer experiences interest or enjoyment in camping since becoming depressed.

  1. Lack of Reactivity to Pleasant Events
A person with melancholic depression may have difficulty reacting positively to a pleasant event or situation. Her mood may slightly improve in response to something positive, but will likely revert back to her previously depressed mood.

  1. Distinctly Depressed Mood
A person may report or exhibit a depressed mood that is obviously different from his mood when he is not depressed, or when he is sad in response to a situation or event.

  1. A.M. Depression
Symptoms of melancholic depression are typically worse in the morning than at other times of the day. This can be based on self report or observation.

  1. Early Morning Awakening
Early morning awakening is defined as waking up at least two hours before the usual wake-up time. This early awakening is not a result of being awakened by an outside influence (e.g., alarm clock, loud noise, etc.).

  1. Psychomotor Retardation or Agitation
Psychomotor retardation is significantly decreased activity or movements that are much slower than usual. Psychomotor agitation is the opposite---increased activity or movements that are much faster than usual. These changes can often be observed by other people.

  1. Weight Loss
People with melancholic depression may experience significant weight loss, perhaps to the point of anorexia.

  1. Excessive Guilt
Excessive guilt is characterized by feeling guilt that is an inappropriate response to a situation or event. For example, a person may accidentally dial a wrong number, and feel excessive guilt about doing so that would be more intense or last longer than what is usual in such a situation.


The three most common treatments for depression are psychotherapy, medication, and electroconvulsive therapy. Psychotherapy is the treatment of choice for people under 18, while electroconvulsive therapy is only used as a last resort.

Melancholic depression does not respond well to psychotherapy and counseling, since it is a fairly severe psychotic mental disorder. Hence, treatment mainly comprises of physical intervention via drugs that involve antidepressant medications, and an extended follow up period.

Electroconvulsive therapy (ECT) or “shock treatment” is also used as a treatment modality for melancholic disorder. Under anesthesia, the patient is given a brief and very mild electric shock which lasts for a fraction of a second and is delivered to the brain through electrodes. This type of treatment is said to be quite effective for psychotic depression such as melancholic depression disorder.

Hospitalization is sometimes also required if the depression is severe and the afflicted and depressed person is feeling suicidal. As is supposed to be the case for all other forms of treatment, medical professionals will explain and discuss the advantages, possible side-effects and alternative options for treating the melancholic form of depression.

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