Melancholic depression and non-melancholic depression: where do these fit into the depression landscape?

by Martin

in Depression Diagnosis

Melancholic depression: 'there have been sightings of her' by Martin Grover


When I began my research into causes, classifications and cures for depression, I came across the categorization of ‘melancholic’ and ‘non-melancholic’ depression.

At first, I didn’t really understand how these fitted into the other definitions of depression I had seen.

Now, I realise that that was not surprising, since this categorisation represents something of a departure from the the hierarchical definitions of depression in the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSMIV TR).

DSM IV classifies the different types of depression largely according to severity of episode and duration.

However, the melancholic/non-melancholic distinction, which is particularly championed by Australia’s Black Dog Institute, differentiates mainly by reference to underlying causes and characteristics of the condition.

After having recently been assessed under the Black Dog Institute’s Mood Assessment Programme (available in Australia by GP referral), the value of the melancholic/non-melancholic model became more clear to me.

This model posits 3 main sub-types of major unipolar depression: Pyschotic, melancholic and non-melancholic.

In all three types significant mood disorder is present – a depressed mood with low self esteem and so on, which is present for two weeks or more and affects normal functioning.

But, significantly, psychotic depression and melancholic depression are considered to be biologically or physiologically based and are typified by significant physical symptoms (technically, psychomotor disturbance). In the case of psychotic depression, this is accompanied by delusions, hallucinations etc.

Melancholic depression is much less prevalent but considerably more severe than non-melancholic depression. Typical symptoms are:

  • Obvious loss of interest in or pleasure from activities that formally gave pleasure (anhedonia),
  • Non-reactive mood – i.e. not cheered up by the occurrence of something funny or pleasant,
  • Mood and energy is usually lower in the morning,
  • A sense of emptiness and inability to get things done, e.g. get up, shower, eat in the morning, go out of the house or cut the grass
  • Observable psychomotor disturbance; this includes cognitive problems such as poor concentration and problems with decision making, as well as physical signs such as showing no emotion, looking empty or lost, being slow of movement or conversely displaying agitated movement or expressions and/or the inability to be comforted or reassured.

In contrast, non-melancholic depression is a residual grouping of other kinds of depression, the contributing causes of which are likely to be more external than internal. According to the Black Dog Institute’s materials, these kinds of depression include:

  • Acute stress-induced depression – also known as ‘adjustment disorder with depressed mood’. This is a reaction to an extreme stressor. Personality type is not usually relevant and the chances of spontaneous remission are high.
  • Chronic stress-induced depression – caused by persisting, long term stressors which compromise the sufferer’s sense of ‘mastery’. In its pure form, personality type is not a predisposing factor for this type of depression. The idea here is that conditions of long term stress induce a sense of lost control over your life, which in turn induces the depression.
  • Personality-contributed depression – this is where your personality type predisposes you to depression and (as a double whammy) operates to maintain depression once it occurs. Often this may be triggered by a stressful situation which, as a result of personality type, leads to depression. Anxious people, in particular, are at risk here.
  • Anxiety-induced depression – This is where long term anxiety disorders, such as social phobia, obsessive-compulsive disorders, panic, agorophobia or generalised anxiety disorders, “drive” the depression.

It’s also noteworthy that you can be suffering from more than one of these sub-types at the same time. So, for example, it looks I’m the proud owner of the delightful combo of chronic stress-induced and personality-contributed depression.

The advantage of all this, it seems to me, is that it helps give you a better understanding of what is behind your depression and therefore a better prospect of focusing your treatment efforts in exactly the right places.

Resources

The Black Dog Institute

Parker, G (2004), Dealing with Depression: A Common Sense Guide to Mood Disorders. (Second Edition) Allen & Unwin. A comprehensive overview of depression from an Australian perspective.
Dealing with Depression: A Commonsense Guide to Mood Disorders (Kindle Edition)


Songs Of Mirth And Melancholy by Branford Marsalis and Joey Calderazzo

Main Image: There have been sightings of her, acrylic on canvas, 130cm x 110cm, by Martin Grover

About the Author

Father, husband, writer and website publisher, discontented in his day-job, he writes here about depression - his own and in general. You can follow Too Depressed on Twitter. Please share the content on this site with all your friends, followers and contacts using the buttons above.

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Last revised on December 10, 2012

{ 2 comments… read them below or add one }

Vhinz March 22, 2012 at 5:42 pm

Hi Martin,

Just an addition to your blog post. A Melancholic depression is a classic form of biological depression which is very distressing condition. The person is known to have varied moods and dissatisfaction towards everything they do. Just my 2 cents.
Vhinz recently posted..Treatment for DepressionMy Profile

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holtight October 4, 2012 at 12:56 am

Depression is often a manifestation of a more generalized adjustment disorder: a crippling, maladaptive behavioral inhibition response to stressful life events. A proven effective ways to combat depressive symptoms associated adjustment disorder is to adopt an active approach to treatment: That is, training oneself to replace undesirable behaviors with healthier behavioral patterns. Within this framework, there is no need to/ and we can bypass any focus on uncovering or understanding any unconscious motivations that may be behind maladaptive behavior. In other words, the symptom itself IS the disease; forget trying to find out why you behave the way you do, just change your behavior. Sound like a simple concept? It is…. but, often quite difficult to execute, and requires dedication and commitment, even in the face of repeated disappointment and frustration. Remember though, the joy comes from “doing”.

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