Updated September 25, 2018
Reviewer Wendy Boring-Bray, DBH, LPC
We all experience feelings of melancholia on occasion. When we lose a job, or go through a tough breakup, we can find ourselves feeling sad and hopeless. While these feelings are a normal part of being a human, if they persist and begin to negatively affect your everyday life, you may have what is known as melancholic depression.
What Is Melancholic Depression?
Melancholic depression is a subtype of major depressive disorder (MDD), which is characterized by overwhelming and intense feelings of sadness and hopelessness, even when there is seemingly no catalyst. MDD affects every area of life, including work, school, and interpersonal relationships. Often those suffering from depression will lose interests in hobbies and activities that they once enjoyed, and may cut off contact with those closest to them. Out of nowhere, those with melancholic depression often lose interest in everything for extended periods of time.
Symptoms Of Melancholic Depression
Overwhelming and persistent feelings of sadness and hopelessness
Those with melancholic depression often lose the ability to feel pleasure. Confronted by feelings of worthlessness and extreme sadness, these feelings are all-encompassing and feel as though they will never end. These symptoms are not brought on by a specific event, but rather appear to come out of nowhere.
Complete loss of interest in activities once enjoyed
Even surrounded by positive events, great friends, and activities in which they once found pleasure in, those suffering from extreme depression feel no happiness. Events that they once looked forward to are now simply neutral. Even if a day is seemingly 'good,' or if they receive wonderful news, it doesn't do anything to alleviate the feelings of depression.
Thoughts of self-harm
While not a symptom in everyone diagnosed with depression, those with more extreme depression may have thoughts of suicide or self-harm.
Disruption in sleep patterns
Depression can negatively affect sleep patterns, either leaving the person too sad to get out of bed (leading to excessive sleep) or disrupting sleep entirely (leading to a lack of sleep).
Significant weight loss
Loss of interest in most things includes lack of interest in food. Often those with melancholic depression will lose their appetite, leading to significant weight loss.
Difficulty concentrating, lack of energy, and inability to make decisions
Fatigue is a very common symptom, and even the simplest tasks can seem extremely difficult. It can also be difficult to concentrate on anything or make decisions because there doesn't seem to be any reason to move forward.
Feelings of guilt
Another symptom that differentiates melancholic depression from major depressive disorder is excessive feelings of guilt. These feelings of guilt are not brought on by a certain situation or event, but rather linked to past experiences or the worry of doing something wrong in the future.
Symptoms worse in the morning
As opposed to major depressive disorder, melancholic depression is characterized by symptoms that are worse in the mornings. This may lead to difficulty getting out of bed and an inability to face the day ahead. Symptoms may begin to recede slightly as the days go on.
What Causes Melancholic Depression?
The important thing to note is that melancholic depression isn't caused by a specific traumatic event, although a traumatic event can trigger depression that may have been lying dormant. Biological factors cause this type of depression; in some cases, it may have been inherited from parents. Those with other mental disorders where psychotic symptoms are present are thought to be more susceptible to this type of depression, as well as elderly patients with dementia.
How Is Melancholic Depression Diagnosed?
As opposed to physical illnesses, diagnosing mental illnesses isn't as clear-cut of a process. Doctors can't simply take an x-ray, analyze a blood sample or see any physical problems. Instead, they rely on a handful of questions that will allow them to determine whether the patient is truly depressed or is simply going through a difficult time.
The patient will be required to talk about a typical day - their behaviors, emotions, thoughts and overall lifestyle. The doctor will try to dig deeper, asking if they have had experienced any traumatic events either recently or in the past that may be contributing to feelings of melancholy. Gathering information on the history of mental illnesses in the family will also be helpful since mental illnesses are often hereditary.
To be diagnosed with melancholic depression, you must be exhibiting at least five of the above symptoms for at least two weeks straight. Before making a diagnosis, a doctor will try to rule out any physical illnesses that may be indirectly causing feelings of depression.
How Is Melancholic Depression Treated?
Medication - Many patients diagnosed with melancholic depression will be put on antidepressants. This regulates the levels of serotonin and dopamine in the brain, bringing the mind back to a manageable state. Antidepressants typically take between 2-4 weeks before they begin to work, and during that time suicidal thoughts may increase before emotions are regulated. It's important to stay in contact with your doctor and let them know if you feel as though suicidal thoughts have increased. It is also important to not stop taking antidepressants even when you begin to feel better until your doctor approves and helps you reduce your dosage gradually.
There are many different types of antidepressants, and it may take a bit of time for a doctor to find the right dosage and medication for you.
Cognitive Behavioral Therapy - Cognitive Behavioral Therapy (CBT) acknowledges that the way we think and behave affects our everyday life. It pinpoints negative thought patterns and works to change them back into more positive thought patterns. A therapist will help you take the steps necessary to restructure the way you think. Since melancholic depression is so severe, CBT is often combined with medication or other types of psychological treatment.
Interpersonal Therapy - Interpersonal Therapy (IPT) focuses on your interpersonal relationships, and pinpoints areas that may be exacerbating your symptoms of depression. This type of therapy aims to help patients improve their relationships or alter their expectations of them. IPT also aims to help develop a stronger support network to deal with symptoms of depression more easily.
Learning to manage melancholic depression is a long process, but there is hope. If a loved one of yours is suffering from depression, it's important to convince them to get the help they need as soon as possible. While it may be a long road to recovery, the combination of medication, psychological treatment, and a strong support system can help alleviate symptoms and help them get on the path to a happier, healthier life. It's very important to remain a supportive confidante throughout the entire process; people suffering from depression often feel worthless, and it's important to remind them that they are not alone. Acknowledging that there is a problem is the first step, and making that initial appointment is the most difficult part. Afterwards, everything else is a step in the right direction.
If you feel as though you are suffering from melancholic depression, seek help today. The trained therapists at BetterHelp are available 24/7 to discuss your symptoms and provide treatment, and there is no need to leave the comfort of your own home. You can remain anonymous, talk with a professional that you feel comfortable with, and revolve sessions around your schedule. Don't wait to get help - the sooner you contact a trained professional, the sooner you will be on the path to a healthier, happier life.
If you or a loved one are having thoughts of suicide, don't wait to hear back from a therapist - call an emergency center immediately.