Is Melancholy the Same as Depression?

Melancholy is a type of extreme depression that makes people lose interest in almost all activities.

Melancholy or melancholia is a severe form of depression and it is now termed “melancholic depression.”

The word “melancholia” is a Greek word to describe the feeling of intense sadness and hopelessness. Melancholic depression makes people lose interest in almost all activities.

Melancholy was considered a separate mental illness. Now the American Psychiatric Association (APA) classified it as melancholic depression under the major depressive disorder (MDD). However, some researchers do not agree with this inclusion. They strongly believe that melancholy should be considered as a distinct mental disorder from depression.

The symptoms of melancholia are like the symptoms of depression but they are severe. The distinctive features that differentiate melancholic depression from non-melancholic depression include

• Feeling profound despair or emptiness
• Experiencing depression becoming worse in the morning
• Waking up two hours earlier than usual in the morning
• Moving more slowly than normal or moving faster and/or more irregularly 
• Experiencing weight loss
• Having excessive or unreasonable feelings of guilt

There are no specific triggers for melancholic depression. Episodes commonly arise “out of the blue.” Unlike depression, happy situations do not improve the patient’s mood even for a short time.

Like depression, the exact causes of melancholic depression are not clear. However, some researchers believe biological changes in the brain to be the causative factor.

Being older, hospitalized and mentally unstable puts people at an increased risk for melancholic depression.

Treatment of melancholic depression uses the same medications targeted for depression and psychotherapy or counseling in general. The medications include

• Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine, paroxetine, sertraline and escitalopram.
• Serotonin-norepinephrine reuptake inhibitors (SNRIs): Duloxetine and venlafaxine.
• Norepinephrine and dopamine reuptake inhibitors (NDRIs): Bupropion.
• Atypical antidepressants: Mirtazapine, trazodone, vortioxetine and vilazodone.
• Tricyclic antidepressants (TCAs): Imipramine, nortriptyline and amitriptyline.
• Monoamine oxidase inhibitors (MAOIs): Tranylcypromine, phenelzine and isocarboxazid.

Melancholic depression can create major disturbances in a person’s daily activities. Though medications are an effective way of treating melancholic depression, you can cope with it by following simple steps. These include

• Relaxation techniques: Deep breathing, meditation and yoga are effective relaxation techniques.
• Long walks and relaxing baths: Long walks in nature and warm baths can help reduce mental stress and make you feel better.
• Regular exercise and a healthy diet: These two things in combination can help decrease the severity of melancholic depression.
• Massage therapy: Massage therapy with oils calms your nerves and helps you relax.
• Psychotherapy: You can visit a therapist to receive psychotherapy or hypnosis or to learn biofeedback training.
• Get adequate sleep: Sleep deprivation can worsen your depression. Try to get seven to nine hours of sleep every night.
• Look for support groups: There are dedicated support groups available for various diseases. Search for one online or in your area for melancholic depression.

If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255 for support. If you or a loved one needs immediate help, call 9-1-1.