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Melancholic Depression

Also known as Depression with Melancholic Features, this category describes Major Depressive Episodes where the depressed mood becomes very dark and profound, and where physically the person seems to be sickly and wasting away.  

Specifically, according to the DSM-IV-TR criteria, the person shows either or both of the following symptoms:

  • A nearly complete loss of pleasure in all areas of life
  • A depressed mood that does not brighten at all to any positive events

In addition, the person experiences three or more of the following symptoms:

  • The depressed mood is felt to be distinctly different in quality from any other kind of low mood that the person would otherwise experience, for example after the death of a loved one.
  • The depressed mood is worse in the mornings
  • The person has early morning awakenings, where they wake up at least two hours before their usual time of waking and are unable to fall back asleep.
  • Physically, the person seems either very lethargic or very agitated.
  • The person has a significant loss of appetite and/or weight.
  • The person experiences excessive or inappropriate guilt.

Melancholic Depressions tend to be more severe, but to last for a shorter duration, than non-melancholic episodes, and are more frequent in men than women [ref]. Melancholic Depressions also seem to occur more often in the absence of any identifiable life stressors or personality issues [ref]. These kinds of episodes tend to respond less well to psychotherapy and more robustly to medications and ECT, and to be more associated with biological markers such as abnormalities on the Dexamathasone Suppression Test [ref].


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