Major depression has five subtypes, called specifiers by the DSM. These are melancholic depression, atypical depression, catatonic depression, postpartum depression and seasonal affective disorder. It is important to acknowledge the subtypes, as they are different experiences of depression often entailing different treatment needs. Remember depression is most definitely not a one-size-fits-all condition; it’s a complex condition existing on a wide spectrum. Patients who display reasonably distinct clusters of symptoms often fall within a subtype.
Melancholic depression is identified and diagnosed by people having one of the following:
- Anhedonia – inability to find pleasure in positive things
- Lack of mood reactivity
And at least three of the following:
- Severe weight loss
- The depression is subjectively different from grief or loss
- Psychomotor retardation (slowing down) or agitation (speeding up)
- Early morning awakening
- Excessive guilt
- Worse mood in the morning
Persons suffering melancholic depression are far more likely to be hospitalised for their depression. Melancholic depression is a significantly altered and noticeable mental state. In this case of depression psychotherapy is not likely to be successful, at least not until a course of antidepressants has begun.
Melancholic depression responds better to physical therapies, like taking anti-depressants. The causes for this type of depression are mostly biological, so a genetic influence can normally be traced, however major stressful life events often trigger episodes, such as a divorce or job loss.
The melancholic subtype often scores much higher on screens for depression than nonmelancholic depression types. It is relatively uncommon; around 10% of people diagnosed with a major depression disorder will experience the melancholic subtype, so about 2% of the population would experience it, certainly under 5%, and it is evenly distributed between the genders.
Because of its severe nature, spontaneous remission is unlikely, and it really needs careful and appropriate diagnosis and treatment. The three most common treatment interventions are psychotherapy, antidepressants and electroconvulsive therapy (ECT). ECT remains a last-resort against severe treatment resistant depression.
As this type is likely to be found in the elderly there can be some confusion about melancholic depression or dementia.
Melancholic depressives may also ruminate over the same thoughts and experiences, and feel excessive guilt. Their depression takes on a life of its own: the more episodes they have, the more autonomous such episodes seem, less likely to be set off by stressful events.*
At How I Beat we always want to frame information around the context of personal recovery stories. Some of this information is easier to understand when put in the context of a real person going through a real ordeal.
We have successful stories of recovery from melancholic depression. We encourage you to look at Graeme Cowan’s story or Abraham Lincoln’s story, two men who had the melancholic subtype of major depression. In Lincoln’s case the diagnosis is based on recorded experience and he didn’t have the wide range of psychiatric medications now available.
Do people beat melancholic depression?
The answer is yes, even though this is a severe type of depression often resistant to different types of treatment. You often find sufferers cycling through many different types of medications and different treatment modalities. It is treatable and beatable, but we stress this is often done in conjunction with clinical settings in therapies, hospitalizations are often required as it is not uncommon for sufferers of melancholic depression to be suicidal. There is also evidence that attending mutual support groups alongside mainstream treatments can be also very beneficial.