What Are The Causes, Symptoms, And Treatment Of Melancholia (Melancholic Depression)?

Many people experience symptoms of depression without realizing it. For example, feeling exhausted, experiencing a change in sleep and appetite patterns, and a frequently low mood can be signs of an underlying mental health condition like depression. 

Occasional sadness can be normal and healthy. However, if you frequently experience melancholy or sadness along with other depression symptoms, speaking to a mental health professional may be beneficial. With a treatment plan and compassionate support from family members or friends, people living with melancholic depression can acquire the tools and knowledge to manage the symptoms of this challenging condition, as this distinct form of depression is highly treatable.

What are the symptoms of melancholic depression?

Compared to other depressive disorders such as major depressive disorder (MDD), which is characterized by a depressed mood, people with melancholic depression show a markedly diminished interest or pleasure in previously enjoyed activities. People with this subtype of major depressive disorder may also experience one of the following two symptoms: 

• Anhedonia, which is difficulty enjoying daily activities 
• Lack of reactivity to positive events

In addition to one (or both) of these symptoms, people with melancholic depression must also exhibit at least three of the following severe symptoms: 

• Emotional disturbances, including feeling numb 
• Disturbances in the psychomotor system, such as slowed thought, movements, or speech
• Cognitive impairment, including reduced concentration and working memory
• Appetite changes 
• Intense persistent feelings of guilt or hopelessness 
• Reduced libido
• Reduced mood and energy levels

Melancholic features of depression often mirror symptoms of major depressive disorder but are considered more severe. People with this condition often experience an overall “slow-down” in their thoughts, movements, and speech, although they may sometimes veer toward agitation and restlessness, they also may have trouble concentrating on tasks. Additionally, as a result of appetite changes, individuals with this form of depression may experience significant weight loss or gain. 

It is also possible to feel more symptoms in the morning. Morning melancholic features include waking up early, feeling empty, or having symptoms that are consistently worse in the morning. 

In more severe cases of melancholia, people may experience and express thoughts of suicide or self-harm. If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. They are available 24/7 to offer support. 

What causes melancholic depression?

Like other mental health conditions, psychologists believe some people are genetically predisposed to developing melancholic depression. Depression is considered 40% to 50% hereditary, so people with a family history of depression, mood disorders, and related conditions may develop this type of depression or another type. In addition to genetic factors, biological factors can also play a role in melancholic depression. When depression is considered biological, it may be referred to as endogenous depression. 

Are melancholic and endogenous depression the same?

Some mental health professionals use endogenous depression as a synonym for melancholic depression since many of the symptoms of this disorder appear unrelated to a person’s external stressors. In these cases, scientists contend that chemical changes in the brain can inhibit sensations of pleasure and induce feelings of melancholy. 

While environmental factors do not always play a predominant role in melancholic depression, it’s still possible for external events to catalyze or worsen a person’s depressive symptoms. For example, low temperatures and a lack of sunlight can increase the likelihood of a type of depression called seasonal affective disorder (SAD). 

Before diagnosing melancholic depression, an experienced medical health professional may consider a person’s environment, complete health history, and motivations and goals for treatment.

Diagnosing melancholic depression

Melancholic depression is recognized in the DSM-5 as a subset of major depressive disorder. However, clients might receive a diagnosis of major depression with “melancholic features.” Regardless of how your physician frames the diagnosis, ask for clarity and ensure that you understand the diagnosis.

When you meet with your physician, they may ask about your daily behaviors, emotions, thoughts, and overall lifestyle. Your therapist or psychiatrist may also inquire about recent events or stressors that could contribute to feelings of melancholy. Try to impart your knowledge of your familial history of mental illness, current medications, and other diagnoses you may have.  

To meet the diagnostic criteria for melancholic depression, many clients may be required to have experienced the symptoms for most or every day for two weeks in a row. 

How is melancholic depression treated?

Depending on the severity of symptoms, mental health professionals often advise combining the following effective treatment methods for melancholic depression. 

Lifestyle changes

When people receive a mental health diagnosis, such as major depressive disorder, minor lifestyle changes can often relieve symptoms in conjunction with professional treatment. Your physician or therapist may recommend some of the following changes to improve your mental health and quality of life:

• Writing in a journal to process and reflect on your emotions and daily events
• Going outside and connecting with nature
• Engaging in physical activity, such as dancing, biking, or hiking
• Spending quality time with friends, family, and loved ones
• Getting enough sleep and adequate nutrition

By committing to these changes, you may notice significant improvements in your mental, physical, and social health.

Psychiatric intervention: Medication 

Depending on the severity of the symptoms of your disorder, some doctors may prescribe medications. According to the American Psychiatric Association, older antidepressants such as tricyclic antidepressants and mood stabilizers are often offered, additionally, a psychiatrist may prescribe serotonin norepinephrine reuptake inhibitors, selective serotonin reuptake inhibitors, or monoamine oxidase inhibitors to treat depression. Your psychiatrist or doctor can help you understand their choices when prescribing and may answer any questions that you may have. Therapists cannot prescribe medications, so consult a psychiatrist or primary care physician before starting, changing, or stopping any medication or medical treatment for depression. 

In addition to medication such as selective serotonin reuptake inhibitors, for severe major depression cases that have not responded to other treatments, a psychiatrist may prescribe electroconvulsive therapy (ECT). ECT involves using electrical impulses to stimulate brain activity while the patient is sedated. Peer-reviewed studies and research have shown ECT to be effective in treating major depression and schizophrenia. 

Therapy and support groups

Modern therapy and support groups are available in various formats, and many certified therapists now offer in-person and online services. 

One of the most common treatments for people with melancholic depression is cognitive behavioral therapy (CBT), which can help clients understand how their thoughts shape their behaviors. CBT challenges people to replace unhealthy beliefs with healthy, positive ones. Another standard therapy for this form of major depressive disorder is interpersonal therapy (IPT), which helps clients resolve any relational challenges that could exacerbate unhelpful thoughts and behaviors.

Alternative counseling options 

While more research is needed to establish the efficacy of online CBT or talk therapy for people experiencing melancholic depression, past studies show that internet-based CBT can be an effective option for clients lacking the time or finances for in-person therapy. A 2018 meta-analysis of controlled trials from a ten-year period (2006-2016) found that therapist-supported online CBT was as effective as in-person CBT in reducing depressive symptoms. 

Online therapy

In addition to effectively reducing symptoms of melancholic depression, major depressive disorder, bipolar disorder, and other mental health conditions, online therapy can reduce the stress of commuting to a therapist’s office. Using an online platform like BetterHelp, you can match with a licensed therapist and discuss your mental health concerns from anywhere at any time. Through an online platform, you can choose between phone, video, or live chat sessions where you can message your therapist at any time.