Getting Help for Melancholia

Getting Help for Melancholia


A woman in a dark room watches the sunrise out her window.There are many treatments for melancholic depression. Experts recommend using a combination of medication and therapy, as these practices often work better in tandem than they do alone. Someone with melancholia may also use alternative treatments such as acupuncture. 

THERAPY FOR MELANCHOLIC DEPRESSION

Melancholic depression is often more resistant to psychotherapy than other types of depression, so recovery may be slower. When treating melancholia, therapy is often used alongside medication.

Psychotherapy is likely to focus on managing symptoms rather than exploring why a person is depressed. For example, someone in cognitive behavioral therapy (CBT) may work on improving self-esteem. A person may learn to spot when their guilt or shame are excessive. With practice, they can learn to counter those negative thoughts with more balanced viewpoints. 

Someone with melancholic depression may also benefit from group therapy. In group therapy, an individual can talk with others who share their condition. If the person has isolated themselves due to depression, group therapy can offer social support.

Therapy can be particularly important if a person has co-occurring mental health concerns. An issue such as addiction may worsen melancholic symptoms if left untreated. 

MEDICATION FOR MELANCHOLIA

Psychiatrists usually treat melancholic depression with antidepressants. These drugs help serotonin and norepinephrine travel more easily through the brain. These chemicals in turn can help people feel better.

Melancholia often responds better to the older drugs (MAOIs and TCAs) rather than the newer drugs (SSRIs). However, the older drugs tend to have more side effects. Individuals who need medication may wish to review the pros and cons of each drug with a mental health professional.

People taking medication for mental health concerns are typically advised to continue working with their therapist or counselor while taking medication. Side effects can be addressed with one's therapist or counselor. 

OTHER TREATMENTS FOR MELANCHOLIC DEPRESSION

Some treatments may be helpful in supplementing therapy and medication. For example, a 2007 study found acupuncture was about as effective in reducing depressive symptoms as SSRIs.

Electroconvulsive shock therapy has also been used as an effective treatment for melancholic depression. In ECT, doctors deliver electrical currents to a person’s brain, causing short, controlled seizures. One study found 62% of people who used ECT for melancholia went into remission.

Doctors may use ECT in severe cases of depression that don’t respond to other treatments. They may also use ECT on seniors who might react poorly to medication. Modern research has made ECT much safer than it was before. Yet there are still risks of memory-related side effects, so many professionals only recommend it as a last resort. 

According to Mental Health America, a practice called Cranial Electrotherapy Stimulation (CES) may eventually replace ECT. Unlike ECT, CES can be done by oneself without medical supervision. The electric current used in CES is low enough that most people do not feel it. Any side effects seem to be mild or rare. However, more research is needed on how the process works and its effectiveness before CES can have widespread use.

HELPING A LOVED ONE WITH MELANCHOLIA

It can be difficult to watch someone you love go through melancholic depression. Here are some ways you can support them:

  • Help them get started in the morning: Melancholia symptoms tend to be worst when a person wakes up. If you can help your loved one with their early tasks, you may give them the momentum they need to get through the day.
  • Try to make sure they eat regularly: Even if your loved one doesn’t feel hungry, their body still needs food. 
  • Avoid judgmental phrases like “snap out of it”: Like diabetes or epilepsy, melancholia cannot be overcome through willpower alone. People with melancholia require time and professional treatment before they can get better.
  • Don’t take their mood personally: People with melancholia can struggle to feel happy about even the most exciting news. Your loved one’s unhappiness does not reflect on your relationship or how much they care about you.
  • Know when to get help: If you think your loved one is about to harm themself, you can call 911 or the National Suicide Prevention Lifeline: (800) 273-8255. It is usually best to assume all suicide threats are sincere.

CASE EXAMPLES OF MELANCHOLIA TREATMENT

  • Melancholia and disaffected mood: Lenn, 62, seeks counseling to help with a perpetual state of worry. Ze is always anxious about something, whether it’s an upcoming dental appointment, bad weather, or house repairs. The transition into colder weather has made these feelings even more prominent. Lenn has noticed it's been difficult lately to wake up and function properly in the morning. A therapist works with Lenn to sort through challenging feelings and adjust, emotionally and physicially, to the change in weather. Lenn invests in a lamp designed to ease seasonal depressive issues. Ze commits to journaling every morning, which is when the worries are strongest. Lenn continues to engage in talk therapy to examine underlying issues and maintain general well-being.
  • Melancholic depression and antidepressants: Yasmin, 32, has just had her second child. She feels buried under the weight of postpartum depression. Her depression is much worse than it was after her first child, and her partner urges her to seek a psychiatric evaluation and psychotherapy. An assessment determines that in addition to postpartum depression, Yasmin is experiencing melancholic symptoms. Those include a disinterest in spending time with her children, inhibited motor skills, and constant guilt. In addition to therapy, her psychiatrist recommends an antidepressant medication. As she is not breastfeeding, Yasmin decides to begin with a low dose. She also joins a group therapy session of other mothers with postpartum depression. Their stories help ease Yasmin’s guilt. Yasmin gradually regains her enthusiasm about family events and maintaining friendships.

If you have melancholic depression, recovery is possible. The right therapist can help you manage your symptoms and regain hope in your life. There is no shame in getting the support you need.

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. Cranial electrotherapy stimulation. (n.d.) Mental Health America. Retrieved from http://www.mentalhealthamerica.net/list-cam-treatments
  3. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  4. Kerner, N. & Prudic, J. (2014). Current electroconvulsive therapy practice and research in the geriatric population. Neuropsychiatry, 4(1), 33-54. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4000084
  5. Li, S. J. & Liu, T. (2007). Clinical observation on treatment of melancholia by acupuncture following principle of relieving depression and regulating mentality. Chinese Journal of Integrated Traditional and Western Medicine, 27(2), 155-157. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17343005
  6. Melancholic depression: Symptoms, treatment, tests, and more. (2016, March 10). HealthLine. Retrieved from https://www.healthline.com/health/depression/melancholic-depression#Overview1 
 

Last updated: 09-19-2018

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