What You Need To Know About Melancholic Depression

Do you suffer from depression, but nothing improves your mood? Do you struggle to respond positively to good news? Do you sometimes lose the battle to get out of bed in the morning? Do you feel like your depression symptoms are just more extreme?

You might have depression with melancholic features, a severe, debilitating form of clinical depression. It makes daily activities unenjoyable, but what differentiates it from regular depression? Let’s take a look.

What is Melancholic Depression?

For a health professional to diagnose you with depression, you must be experiencing symptoms such as persistent feelings of sadness or hopelessness, irritability, fatigue, change in appetite, increased or decreased eating and sleeping, brain fog or difficulty concentrating, feelings of shame or guilt, and thinking about passively dying or suicide. The most common diagnosis is major depressive disorder (MDD.)

Previously its own disorder, melancholic depression is now a subtype of MDD. On top of the standard MDD symptoms, features of depression with melancholy include:

  • Worse depression symptoms in the morning hours
  • Lack of emotion, even positive ones
  • Loss of pleasure, called anhedonia
  • Extreme agitation
  • Worsening sense of despair
  • Deep feelings of worthlessness
  • Hypersomnia or excessive sleep
  • Early morning wakings
  • Inability to get out of bed, medically called anergia
  • Significant weight loss
  • Slowed speech or decreased movement

Diagnosing Melancholic Depression

Your depression cannot be related to grief, physical ailments, or substance use to receive an official diagnosis of melancholic depression. Your treatment team will likely want to rule out the following disorders as well:

  1. Persistent Depressive Disorder

    Also called dysthymia, this disorder has more mild symptoms than MDD, but the symptoms persist for two years or more.

  2. Premenstrual Dysphoric Disorder

    Similar to MDD, but the onset and resolution of symptoms are in time with menstruation instead of more constant. The symptoms must also disrupt your daily life or cause significant distress.

  3. Bipolar Disorder

    Formerly manic depression, you can suffer extreme mood changes ranging from mania to deep depression. The depression phase can look very similar to melancholic depression.

  4. Cyclothymic Disorder

    Similar to bipolar disorder, you can experience ups and downs in your mood, but it’s not as extreme as with forms of bipolar disorder. You can also feel stable and fine between your emotional fluctuations.

Melancholic depression also tends to be more common if you also are experiencing psychotic features. These include symptoms of psychosis, such as delusional thoughts and hallucinations. Hallucinations can affect any of your five senses: sight, touch, smell, taste, and hearing.

Risks for Depression with Melancholic Features

According to research, study participants with melancholic features had more serious past suicide attempts than their counterparts with MDD. These participants also required hospitalization to manage their symptoms than other study participants.

Unfortunately, they also had a higher probability of future suicide attempts. All these findings were independent of depression severity as well. Because of these increased risks of melancholic depression, appropriate treatment interventions are life-saving.

Treating Melancholic Depression

When looking at treatment options, mental health professionals must look at the cause of depression. However, researchers still don’t fully understand the factors that cause the added melancholic component. Although, it likely involves a combination of a genetic predisposition, life events or environmental factors, and biological imbalances, especially in your brain.

Because of this, holistic treatment is crucial. Talk therapy doesn’t tend to treat depression with melancholy successfully by itself, but it helps target negative thought patterns and teaches you healthy coping strategies. Antidepressants restore chemical imbalances in your brain, contributing to your depression. Talk and drug therapy bundled together have a higher chance of success. However, melancholic depression can be more likely to be treatment-resistant, meaning it doesn’t respond well to antidepressant medications after giving different drug classes a full trial.

Another option is transcranial magnetic stimulation (TMS), an advanced depression therapy. TMS is a noninvasive treatment option for MDD. Using magnetic pulses, TMS providers in Washington are restoring brain chemical imbalances without medication. This therapy is well tolerated with little to no side effects because it’s not systemic like medications are.

TMS is already an excellent option for treatment-resistant depression and is a promising treatment option for the melancholic MDD subtype as well. Greater than 71% will respond favorably to TMS. One study found 43% of participants receiving TMS had their depression score reduced by at least half, and all the participants were medication-resistant with the melancholic component.

Psychomotor disturbances such as brain fog, slowed speech, or movements are a hallmark of melancholic depression. This study found that participants with melancholic MDD clinically responded to TMS but experienced significant decreases in their psychomotor symptoms.

Depression can be debilitating, but melancholy adds another level of daily struggles, symptoms, and risks. If you think you might have something more going on than your initial diagnosis or believe you are a candidate for TMS therapy, speak to your treatment team today regarding your options.