Melancholic Depression

Melancholic depression, or 'depression with melancholic features', is a DSM-IV subtype of major depression requiring at least one of the following symptoms: anhedonia (the inability to find pleasure in positive things), or lack of mood reactivity (i.e. mood does not improve in response to positive events) and at least three of the following: depression that is subjectively different from grief or loss, severe weight loss or loss of appetite, psychomotor agitation or retardation, early morning awakening, guilt that is excessive, and worse mood in the morning. Melancholic features apply to an episode of depression that occurs as part of either major depressive disorder or bipolar disorder I or II.

Melancholic depression is often considered to be a biologically based and particularly severe form of depression. Treatment involves antidepressants, electroconvulsive therapy, or other empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression. A 2008 analysis of a large study of patients with unipolar major depression found a rate of 23.5% for melancholic features. It was the first form of depression extensively studied, and many of the early symptom checklists for depression reflect this. The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low. According to the DSM-IV, the "melancholic features" specifier may be applied to the following only:

1. Major depressive episode, single episode
2. Major depressive episode, recurrent episode
3. Bipolar I disorder, most recent episode depressed
4. Bipolar II disorder, most recent episode depressed