Published On: December 16, 2021
Reviewed On: December 16, 2021
Updated On: November 3, 2023
Melancholic depression is a type of major depressive disorder (MDD) that has a dire effect on virtually all areas of life including work, school, and relationships. This severe form of clinical depression causes a near total loss of any sense of pleasure in almost every aspect of daily life.
Though it’s no longer considered its own diagnosis per the DSM-5, some doctors and researchers still believe it should be so that treatment options can be improved.
What is melancholic depression? What are some of the major melancholic depression symptoms and signs? What causes it, how is it diagnosed, do you need to take a depression test, and what treatments are available? Read on to learn everything there is to know about melancholic depression.
Melancholic depression is a subtype, or specifier, for major depressive disorder (MDD). Melancholia is a term that’s been used in psychology since the 5th century B.C. First introduced by Hippocrates, the term is still fitting, as the original symptoms categorized under this melancholic subtype are virtually the exact same as what we use today. Fear, insomnia, lack of appetite or not wanting to eat, restlessness, sadness, and extreme agitation are all symptoms of melancholic depression.
Expert Insight“If things that you once enjoyed doing now feel just a bit empty or emotionless, that could be a sign to look out for as it relates to possible melancholic depression. There is hope, and there is treatment out there, you deserve it.”
There are many melancholic depression symptoms to be aware of if you’re concerned that you or someone you love might be living with this form of depression. Melancholic symptoms are more likely to be seen in people who have very severe major depressive disorder symptoms or who experience MDD with psychotic features.
If you’re thinking to yourself, “my depression is getting worse,” here is a list of symptoms similar to MDD:
Expert Insight“It’s helpful to know your own mental health ‘baseline’ around depression symptoms, meaning, what does a usual day feel like for you, or how do you usually respond to certain stressors? Knowing our own baselines can be helpful, especially when we’re not feeling like our usual selves. So if you’re noticing feelings of more hopelessness, or guilt, or an emptiness, or any changes in your appetite or sleep, it would be helpful to speak with a trusted mental healthcare provider to discuss what’s been going on and to get some support.”
Unlike some other forms of depression, melancholic depression typically isn’t the result of a single triggering event. Specific to melancholic depression is the fact that even when good things happen in your life, the result won’t be an improved mood. While the exact cause of depression isn’t totally understood, a few things come in to play that can increase risk, including:
Melancholic depression is widely accepted to have a strong biological origin. One study shows a signature marker that’s been found only in people with melancholic depression (but not in people with other forms of depression or in people who don’t have any form of depression at all).
Since melancholic depression isn’t recognized by the American Psychiatric Association (APA), making a diagnosis can be a little bit different. Now the APA considers melancholic depression a type of depression. If you have symptoms of melancholy with your depression, your diagnosis would likely be major depressive disorder with melancholic features.
There are a few common questions that doctors will most likely ask during an assessment. Some of them may include:
Wondering if you have a form of depression like melancholic depression? Check out our depression test.
In addition to an evaluation that’s used to assess how severe your symptoms are, it’s not uncommon for your physical health to also be evaluated. This might include bloodwork and additional medical testing to rule out the possibility that some of your symptoms might be related to an underlying medical condition not related to depression.
For a melancholic depression diagnosis to be made, you must show symptoms of melancholic MDD including:
Additional symptoms can also include “can’t get out of bed depression.”
At least three of the following symptoms must be present for a melancholic diagnosis to be made:
Finally, several other conditions will need to be ruled out before a melancholic diagnosis can be made. Some of these issues can include:
Melancholic depression is widely accepted to be the result of a biological route, not something that’s triggered by outside circumstances. Because of this, medication is most often a big part of a treatment plan. Melancholic depression seems to be largely due to brain function and genetic makeup. This means the medication prescribed needs to be effective at addressing biological causes such as brain function.
Some antidepressant treatments that might be prescribed to treat melancholic depression include:
Medication isn’t the only way to treat melancholic depression. Psychotherapy, also commonly known as talk therapy, is an effective form of treatment, especially when it’s combined with medication. For most people, combining these two treatment options can be an effective way to manage melancholic depression.
Therapy for melancholic depression can be done in person or through online therapy sessions. Therapy can show you how to effectively:
Individual one-on-one therapy is not the only option for someone looking to treat melancholic depression. Group therapy has been found effective as well.
Very extreme and severe cases might benefit from electroconvulsive therapy (ECT). By attaching electrodes that send electrical impulses to the brain, a mild seizure is triggered. Even though ECT has been proven safe and effective, there’s still a pretty negative stigma attached to the idea of using it to treat mental health conditions and mood disorders. For this reason alone, it’s generally not the first line of treatment for melancholic depression. That said, combining therapy, medication, and ECT may be an effective treatment option for melancholic depression symptoms if medication and therapy combined aren’t sufficient.
Therapy through Talkspace can be an affordable, effective, and accessible way for you to treat your melancholic depression. If you’re living with MDD with major depressive disorder with melancholic features, it might be time to consider getting the help you need.
Parker, Gordon et al. The American journal of psychiatry vol. 167,7 (2010): 745-7. doi:10.1176/appi.ajp.2010.09101525. Accessed December 7, 2021.
Sadeghfard, Abbas et al. Iranian journal of medical sciences vol. 41,3 Suppl (2016): S75. Accessed December 7, 2021.
Hyett, Matthew P et al. NeuroImage. Clinical vol. 9 660-7. 24 Oct. 2015, doi:10.1016/j.nicl.2015.10.011. Accessed December 7, 2021.
Kate Rosenblatt, MA, LPC, LMHC, was the Senior Clinical Manager at Talkspace until 2022, and is a clinical therapist licensed in CT and NY. A member of the American Psychological Association (APA), Kate completed her Master's degree in Counseling Psychology at Lesley University in Cambridge, MA. She has over 10 years of experience working with adults on a variety of issues, specializing in eating disorders and working with people going through life stressors such as finding your purpose, career changes, and connecting with your intuition.