Melancholic depression is a form of major depressive disorder (MDD) in which the primary indicator is a state of "melancholia."

For a person suffering from melancholic depression, life often seems meaningless or without purpose.

In the U.S., it is estimated that between 12 and 15 percent of women and eight to 10 percent of men will suffer with a serious mood disorder such as melancholic depression during their lifetime. Although melancholic depression has different levels of severity, most researchers classify it as one of the more serious forms of depression as it is often deemed "treatment resistant." It is typically the type of depression experienced by those with bipolar disorder.

What Characterizes a 'Treatment Resistant' Depression?

Some 30 to 40 percent of depressive episodes are considered treatment resistant, as they typically don't respond well to a variety of antidepressants.

In a strict sense, depression is considered treatment resistant if it fails to respond to two or more consecutive medications.

A 2007 European study found that patients whose depressions were most likely to be treatment resistant were those in which panic disorders and/or social phobias were also present. Forty percent of patients in the study reported having either current or lifetime anxiety. Besides melancholia, other traits of treatment resistant depression included the presence of a personality disorder, suicidal ideation, recurrent depressive episodes and the onset of depression prior to the age of 18.

Symptoms of Melancholic Depression

One way to think about melancholic depression is to consider the difference between emotions and moods.

Emotions are constantly changing and respond to a person's thoughts and experiences throughout the day. Moods, on the other hand, are extensions of emotions over time. A mood may last for a few hours, a few days or, in the case of depression, months or even years.

When a certain mood takes over it can change a person's behavior, alter how others perceive him and color his view of himself and the world. In short, melancholic depression can change a person's entire personality.

The primary features of melancholic depression include:

  • ?lack of energy and difficulty "getting going," usually in the morning
  • difficulty facing mundane tasks such as getting out of bed or showering
  • physical and cognitive slowness ("moving or thinking through a fog")
  • inattention or poor concentration
  • intense physical agitation such as pacing or hand-wringing
  • inability to experience pleasure
  • feelings of "emptiness" or "numbness"
  • changes in appetite (typically resulting in weight gain as opposed to weight loss)
  • hypersomnia (sleeping longer than usual)

Diagnosing Melancholic Depression

In order to diagnose melancholic depression, a doctor will usually ask a patient some form of the following questions:

  • Do you have difficulty getting out of bed and getting started in the morning?
  • Are your symptoms generally worse in the morning or in the evening?
  • How do you sleep (or has there been a change in your sleep patterns)?
  • What does a typical day look like for you?
  • Has your daily routine changed?
  • Do you enjoy the same things you once did?
  • What, if anything, improves your mood?
  • Do you have more trouble concentrating than usual?

Treatments for Melancholic Depression

Studies have found that melancholic depression doesn't respond as well to newer selective serotonin reuptake inhibitor (SSRI) antidepressants such as fluoxetines (Prozac) or paroxetines (Paxil). However, many patients with melancholia respond positively to older-style tricyclic antidepressants and serotonin–norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine (Effexor), which inhibit the uptake of both the neurotransmitters serotonin and norepinephrine.

A combination of antidepressants and talk therapy usually works better in patients with melancholic depression than either approach on its own.

However, because it can be especially difficult to treat, electroconvulsive therapy (ECT) has been found to be the most effective treatment for melancholic depression (as well as certain other forms of severe depression).?