What Is Melancholia?

Melancholia


A balding man watches snow fall on trees.Melancholia is a subtype of depression. People with melancholic depression often feel extreme despair and guilt. They may struggle to feel any happiness, even when good things happen in their lives. 

Although melancholia can be difficult to treat, recovery is possible. A trained mental health professional can help people with melancholia cope with their symptoms. 

HISTORY OF MELANCHOLIA

In 400 B.C., the Greek philosopher Hippocrates theorized that the human body contained four major fluids: blood, black bile, yellow bile, and phlegm. A human grew sick when these fluids were out of balance in their body. An excess of black bile would cause someone to become despondent and fearful. The Greeks call this condition melancholia. It became the first term used for depression and the first way depression was ever studied.

During the Renaissance, Europeans considered melancholia to be a sign of creative genius. They glorified it through art, fashion, and written works. But by the 18th century, the term returned to its clinical roots. 

Around the 19th century, people used the term depression synonymously with melancholia. Sigmund Freud’s writings in On Murder, Mourning and Melancholia helped modernize the concept of melancholia into its current definition. 

WHAT IS MELANCHOLIA? 

Today, melancholia is no longer listed as a standalone mental health issue. Instead, the Diagnostic and Statistical Manual (DSM) lists it as a specifier for depressive disorders. Rather than receiving a diagnosis for melancholia, a person is more likely to receive a diagnosis of major depression (MDD) with melancholic features. (Melancholia can also occur during the depressive phase of bipolar.)

To be diagnosed with melancholic depression, a person must present at least one of these symptoms:

  1. Loss of enjoyment from all (or nearly all) activities.
  2. Lack of positive response to objectively pleasurable events.

And at least three of the following:

  1. Despair that is not linked to loss or grief.
  2. Loss of appetite or significant weight loss.
  3. Psychomotor changes: Either physical restlessness or slowed movement.
  4. Diurnal mood variation: Low mood that is worse in the morning.
  5. Waking at least two hours earlier than normal.
  6. Excessive guilt.

MELANCHOLIA AND OTHER TYPES OF DEPRESSION 

Melancholia can look very different from non-melancholic depression. Compared to an individual with another type of depression, someone with melancholia typically:

  • Develops symptoms at a later age.
  • Has more severe symptoms. Instead of having fatigue, the person may have no energy at all. Instead of having a dampened mood, they may be unable to feel any happiness.
  • Is more likely to have psychomotor symptoms. 
  • Is more likely to have anxiety or suicidal thoughts.

Melancholic depression can also occur alongside other specifiers. For example, someone with melancholia may have a seasonal pattern to their symptoms. Research shows melancholia is more prevalent when sunlight and temperature levels are low. Melancholia might also co-occur with postpartum depression and depression with psychotic features.

WHAT CAUSES MELANCHOLIA?

Melancholia is sometimes called “endogenous depression,” meaning “depression that comes from within. The condition is highly heritable. People with melancholia are likely to have a family history of mood issues or suicide. Social and psychological factors rarely contribute to melancholia the way they might with other depression subtypes.

Research suggests differences in the brain may be responsible for melancholia. Someone with melancholia may have less neurons connecting to their insula (the part of the brain responsible for attention). They may also have an altered hypothalamus, pituitary gland, or adrenal glands. These changes may affect a person’s appetite, stress levels, and more. 

EFFECTS OF MELANCHOLIA 

Melancholia can prompt various biological changes in the body. People with melancholic depression spend more time in the REM phase and less time in the deep sleep phase. Thus, they may get less quality rest. 

People with melancholia often have elevated cortisol levels, which increase one’s stress. They may also experience weight loss and chronic inflammation.

The condition can also affect cognitive processing and performance. Research suggests it impedes working memory, visual learning, verbal learning, and problem solving. These symptoms are specific to the melancholic subtype of depression.

Overall, melancholia can impact a person’s relationships, occupation, and health. In severe cases, it may prompt an individual to attempt suicide. Melancholia tends to cause longer periods of suicidal thinking than other types of depression. 

If you or a loved one has melancholia, know that there is hope. A licensed therapist can help you on the journey to recovery. You can find a therapist here.

References:

  1. Brown, W. A. (2007, January 15). Treatment response in melancholia. Acta Psychiatrica Scandinavica, 115(s433), 125-129. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0447.2007.00970.x/full 
  2. Carroll, B. J., Feinberg, M., Greden, J. F., Tarika, J., Albala, A. A., Haskett, R. F., … & Young, E.. (1981). A specific laboratory test for the diagnosis of melancholia: Standardization, validation, and clinical utility. Archives of General Psychiatry, 38(1), 15-22. Retrieved from http://jamanetwork.com/journals/jamapsychiatry/article-abstract/492458 
  3. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  4. Freud, S. (1917). On murder, mourning and melancholia. London: Penguin Group.
  5. Jackson S.W. (2008) History of psychiatry and medical psychology. Boston: Springer.  
  6. Javier, H. (2014). The four humors theory. ESSAI, 12(1). Retrieved from http://dc.cod.edu/cgi/viewcontent.cgi?article=1497&context=essai
  7. Lamers, F., Beekman, A. T. F., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H. (2016). Six-year longitudinal course and outcomes of subtypes of depression. The British Journal of Psychiatry, 208(1), 62-68. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/sixyear-longitudinal-course-and-outcomes-of-subtypes-of-depression/3F3CC68201884E067284379B05F49697
  8. Melancholic depression: Symptoms, treatment, tests, and more. (2016, March 10). HealthLine. Retrieved from https://www.healthline.com/health/depression/melancholic-depression#Overview1 
  9. Parker, G., Fink, M., Shorter, E., Taylor, M. A., Akiskal, H., Berrios, G., … & Swartz, C. (2010. January 1). Issues for DSM-5: Whither melancholia? The case for its classification as a distinct mood disorder. The American Journal of Psychiatry. Retrieved from http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2010.09101525 
  10. Parker, G., Roy, K. Hadzi-Pavlovic, D., Wilhelm, K., & Mitchell, P. (2001). The differential impact of age on the phenomenology of melancholia. Psychological Medicine, 31(7), 1231-1236. Retrieved from https://www.cambridge.org/core/journals/psychological-medicine/article/differential-impact-of-age-on-the-phenomenology-of-melancholia/296E27B2F54AD6B3C03A963CCDB7E975
  11. Radua, J., Pertusa, A., & Cardoner, N. (2010, February 28). Climatic relationships with specific clinical subtypes of depression. Psychiatry Research, 175(3), 217-220. Retrieved from http://www.sciencedirect.com/science/article/pii/S0165178108003946 
  12. Rush, G., O’Donovan, A., Nagle, L., Conway, C., McCrohan, A., O’Farrelly, C., ... & Malone, K. M. (2016, November 15). Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy. Journal of Affective Disorders, 205(1), 60-68. Retrieved from http://www.sciencedirect.com/science/article/pii/S0165032716302762 
  13. Taylor, M.A. & Fink, M. (2006). Melancholia: The diagnosis, pathophysiology, and treatment of depressive illness. New York: Cambridge University Press.
  14. Zaninotto, L., Solmi, M., Veronese, N., Guglielmo, R., Ioime, L., Camardese, G., & Serretti, A. (2016, September 1). A meta-analysis of cognitive performance in melancholic versus non-melancholic unipolar depression. Journal of Affective Disorders, 201(1), 15-24. Retrieved from http://www.sciencedirect.com/science/article/pii/S0165032716302129

 

Last updated: 09-19-2018

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