Causes and Symptoms of Melancholic Depression

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What is Melancholia?

Melancholic depression is categorized by the Diagnostic and Statistical Manual of the American Psychiatric Association, the standard reference for all psychiatric illnesses, as a sub-type of major depressive disorder. Although quite rare, it is considered to be one of the most severe forms of depressive disorders. Here we take a brief look at the causes and symptoms of melancholia.

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.

Psychoanalysis considers this form of depression as the body’s defense mechanism for fighting a depressive state of mind.

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 Melancholia

Psychiatrists use the following symptoms to identify melancholia in individuals:

  • The individual has a clearly visible depressed mood. He or she is not just sad or feeling down due to a specific life event. The depression may be so severe that the person may have suicidal tendencies and may require hospitalization.
  • The person feels more depressed in the morning. He or she also wakes up early in the morning, usually about two or more hours earlier than the usual waking time. The person is also not able to go back to sleep again.
  • Psychomotor disturbances are seen. This can either be in the form of retardation or agitation. Psychomotor agitation or excessive movement is usually seen in younger patients whereas retardation or slowing down of movement is usually seen in the elderly.
  • The person may be anorexic or may experience loss of appetite. Weight loss is also seen.
  • A feeling of excessive guilt may also be present.
  • Extreme lack of energy and extreme lethargy is clearly visible to others. This is especially experienced early in the morning.
  • There is a loss of pleasure in all activities. Any efforts to cheer up this individual are usually in vain and even positive events cannot lift his or her spirits.
  • Excessive loss of libido or sex drive is experienced.
  • Poor concentration and inattention may be present.

Since melancholic depression is primarily considered to have a biological cause, counseling and psychotherapy are rarely effective with this depressive disorder. Treatment via antidepressant drugs is usually the proper intervention approach although electroconvulsive shock therapy may also be required in severe cases.


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