Introduction
Depression is a mental health condition characterized by persistent sadness, hopelessness, or a loss of interest or pleasure in previously enjoyable activities.
Melancholic depression, sometimes referred to as Melancholia- is a term of Greek origin that translates to intense sadness and hopelessness. It is a subtype of Major Depressive Disorder (MDD) characterized by profound sadness, loss of pleasure, or interest in all activities. Melancholic depression (Melancholia) is considered a distinct subtype of depression because of its characteristic symptoms and the fact that it may require different treatment approaches than other types of depression.
What Are the Risk/Causative Factors of Melancholic Depression?
It can affect anyone, but some of the possible risk factors are:
1. Genetics: Individuals with a family history of depression or other mental health disorders may be more likely to develop Melancholia.
2. Age: Melancholic depression is more common in older adults than younger ones.
3. Gender: Some studies suggest that women are more likely to develop Melancholia than men.
4. Medical Conditions: Individuals with chronic conditions such as heart disease, cancer, or chronic pain may have an increased risk of developing Melancholia.
5. Medications: Certain medications, such as corticosteroids, beta-blockers, and some hormonal medications, may increase the risk of developing depression.
6. Stressful Life Events: Trauma, loss, or other stressful life events can trigger depression in some people.
What Are the Symptoms of Melancholic Depression?
Melancholia is seen in individuals already diagnosed with Major Depression- symptoms existing for over two weeks.
Symptoms appear as follows:
-
Anhedonia, or loss of pleasure or interest in almost all activities.
-
Deep sadness, hopelessness, or despair.
-
Significant weight loss or gain and changes in appetite or digestion.
-
Insomnia or hypersomnia (excessive sleepiness).
-
Psychomotor agitation or retardation (slowing down of movements and speech).
-
Feelings of worthlessness, guilt, or self-blame.
-
Difficulty concentrating, making decisions, or remembering things.
-
Recurrent thoughts of death or suicide.
-
Physical symptoms, such as fatigue, aches, or headaches.
-
Lack of response to positive events or situations.
The symptoms of Melancholia are similar to general depression but are usually more severe and persistent. Melancholia causes most people to slow down. Their movements, thoughts, and speech can all be extremely slow. Agitation and restlessness are less common symptoms of Melancholia.
How to Diagnose Melancholic Depression?
Any mental health condition has to be consulted with and diagnosed by a healthcare professional (psychologist/psychiatrist). The American Psychiatric Association (APA) has removed Melancholic depression as a separate identity and combined it under Major depressive disorder (MDD). So, diagnosis is confirmed when there are symptoms of MDD with Melancholia. The therapist will ask questions about the symptoms and diagnose based on the answers.
An individual is said to have Melancholic depression when more than three of the following symptoms are observed:
-
Non-reactivity to circumstances.
-
Psychomotor disturbance.
-
Memory loss and lack of concentration- cognitive impairment.
-
Symptoms of vegetative dysfunction include early morning wakening insomnia (waking up two hours earlier than usual), diurnal mood variation (feeling low in the morning and increasing positive mood as the day progresses), and weight loss.
What Are the Treatment Options for Melancholic Depression?
Melancholic patients are thought to respond better to Electro Convulsive Therapy (ECT) and certain pharmacological approaches, such as tricyclic antidepressants (TCA) and Monoamine oxidase Inhibitors (MAOIs), than to selective serotonin reuptake inhibitors (SSRIs) that are given in patients suffering from MDD.
-
ECT is suggested by the therapist when the individual exhibits severe symptoms that are unresponsive to medication or psychotherapy. It is a procedure done under general anesthesia, which sends electrical signals to the brain. These signals will induce seizures for a short time, thereby causing an alteration to the chemical balance of the brain and relieving the symptoms of Melancholia.
-
TCA drugs usually include Amitriptyline, Amoxapine, Desipramine, Doxepin, Imipramine, Nortriptyline, etc.
-
Psychotherapy or talk therapy: Cognitive Behavioral Therapy is the most effective and common form of psychotherapy.
It involves molding the individual to :
-
Adjust to a traumatic situation or a crisis.
-
Replacing preformed negative thoughts and beliefs with positive and healthy ones.
-
Building self-esteem and self-confidence.
-
Teaching the individual how to tackle a challenging situation and to solve daily life issues that one may encounter.
CBT involves desensitization of the individual's thoughts and feelings, thinking positively, and making decisions accordingly. Interpersonal therapy (IPT) and psychodynamic therapy may also be effective.
However, It is not always as effective in treating Melancholia as it is in treating other forms of depression. It is recommended as it can help individuals form positive thought processes and refrain from negative thoughts.
Natural methods like meditation, following a healthy diet, maintaining physical health by regular exercise, getting adequate sleep, and practicing mindfulness have proven people to overcome symptoms of depression. Additionally, avoiding alcohol and drugs and engaging in stress-reducing activities like yoga can be beneficial.
What Are the Potential Side Effects and Risks of Tricyclic Antidepressants and Monoamine Oxidase Inhibitors?
While TCAs and MAOIs are useful in treating melancholic depression, they do have possible side effects and risks. TCAs can lead to dry mouth, constipation, impaired vision, dizziness, and an elevated heart rate. MAOIs can interact with certain foods and drugs, resulting in severe blood pressure rises. Because of the potential for harmful effects, both groups of medications must be closely monitored by healthcare experts, particularly in older adults or those with underlying medical conditions. When prescribing these medications, it is critical to take into account individual risk factors and schedule regular follow-ups.
Conclusion
In conclusion, melancholic depression is a type of major depressive disorder (MDD) characterized by distinct symptoms. While the exact causes of melancholic depression are not fully understood, it is believed to result from a combination of genetic, environmental, and biological factors, such as imbalances in brain chemicals, stressful life events, medical conditions, and medications. Therefore, it is important to recognize the signs and symptoms of melancholic depression and seek help from a mental health professional if anyone is experiencing them.
Treatment options for melancholic depression may include antidepressant medication, psychotherapy, and other interventions tailored to the individual's needs. Melancholia rarely responds to placebos, psychotherapies, or social interventions compared to non-melancholic depression.
Yet, it is important to work with a mental health professional to develop a personalized treatment plan for melancholic depression that considers the specific symptoms and needs. Proper diagnosis and treatment make it possible to manage the symptoms of melancholic depression and improve one's overall quality of life.
