Melancholic depression is a form of depression, also known as melancholia. As many as 15%-30% of patients with depression fall into this category.
Melancholic depression may have more severe symptoms than other types of depression. It may also be more difficult to treat than other types of depression. But you can learn to manage your symptoms with the help of a mental health professional.
symptom
Melancholic depression is more likely to cause physical symptoms rather than just feeling blue or tearful. You may not have the energy. You feel empty and unable to feel happiness. Your movements and thoughts may slow down.
The two main symptoms are:
- You have lost the ability to enjoy the activities in your life.
- You cannot respond to happiness in a positive way.
Melancholic depression also has the following characteristics:
- Waking up early leads to poor sleep quality
- Loss of appetite or weight loss
- Trouble concentrating or memory problems
- Feeling empty or unresponsive
- Excessive guilt
- Feeling of hopelessness
- Having suicidal thoughts
**Psychomotor signs. ** If you have melancholic depression, your behavior may change. Examples include:
- Changes in speech, or speaking at a different volume or pausing when speaking
- Eye movements when talking to people, such as staring or not making eye contact
- Slow movement of the head, limbs, or trunk
- slouching posture
- Touch your face or body frequently
**Body aches. ** Some studies suggest that approximately 70% of people with melancholic depression also experience musculoskeletal pain.
Who is at risk?
Symptoms of depression usually occur later in life. This type of depression often runs in families. Someone in your family tree may have had emotional problems or even died by suicide.
Melancholic depression symptoms may be worse during times of the year when there is less sunlight, shorter days, or when it is cold outside.
People who suffer from postpartum depression or depression shortly after giving birth may also experience symptoms of depression.
Cause
Changes in the brain and hormonal pathways can lead to melancholic depression. The hypothalamus, pituitary gland, and adrenal glands may not function properly. This pathway is called the hypothalamic-pituitary-adrenal (HPA) axis. These glands release chemicals that regulate stress and appetite.
With melancholic depression, you may have high levels of cortisol, a steroid hormone produced by your adrenal glands when you’re under stress. Your HPA axis regulates it. This can affect many different functions of your body, including your appetite, metabolism, and memory.
There may also be changes in your brain’s signals, called neurons. These signals influence how you react to your surroundings.
Diagnosis
Your doctor or mental health professional will diagnose your depression based on your signs and symptoms.
You must have one or both of the two cardinal symptoms of melancholic depression: a loss of the ability to enjoy life or respond to life’s pleasurable activities.
You must also have at least three of the following symptoms:
-Despair is not caused by grief or loss of a loved one
- Loss of appetite or significant weight loss
- Psychomotor changes
- Feeling depressed, worse in the morning than in the evening
- Wake up at least 2 hours earlier than you want
- Strong feelings of guilt
treat
Treatment for melancholic depression may include a combination of medications and therapy.
**Antidepressants. ** Doctors usually prescribe tricyclic antidepressants (TCAs) for melancholic depression, but they may also use other antidepressants and medications. TCAs include the following drugs:
- Amitriptyline (Elavil)
- Amoxapine (Ascendin)
- Desipramine (Desipramine)
- Doxepin (Prudoxin, Silenor, Zonalon)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
- Protriptyline (Vivactil)
- Trimipramine (Surmontil)
**Electroconvulsive therapy. ** If your other treatments don’t work, your doctor may recommend electroconvulsive therapy (ECT) to relieve your symptoms. While you are under general anesthesia, the technician sends electrical signals to your brain. This can cause you to have a brief seizure. ECT may change your brain’s chemical balance to relieve symptoms of depression.
**Psychotherapy. ** Psychotherapy or talk therapy is not always as helpful in treating melancholic depression as it is in other types of depression. Even after treatment, your symptoms may return later, but you can manage your depression with the help of your doctor and mental health professional.
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