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