Editing Melancholia (section)

==Modern connotations==
Until the 18th century, writings on melancholia were mainly concerned with beliefs that were considered abnormal, rather than affective symptoms.<ref name="auto">{{cite journal |last1=Telles-Correia |first1=Diogo |last2=Marques |first2=João Gama |title=Melancholia Before the Twentieth Century: Fear and Sorrow or Partial Insanity? |journal=Frontiers in Psychology |doi=10.3389/fpsyg.2015.00081 |date=3 February 2015|volume=6 |page=81 |pmid=25691879 |pmc=4314947 |doi-access=free }}</ref>

Melancholia was a category that "the well-to-do, the sedentary, and the studious were even more liable to be placed in the eighteenth century than they had been in preceding centuries."<ref>{{cite book |last1=Wear |first1=A |title=The Oxford Companion to the Body |date=2001 |publisher=Oxford University Press |url=https://www.encyclopedia.com/medicine/anatomy-and-physiology/anatomy-and-physiology/humours |access-date=2022-08-28 |archive-date=2021-10-15 |archive-url=https://web.archive.org/web/20211015123057/https://www.encyclopedia.com/medicine/anatomy-and-physiology/anatomy-and-physiology/humours |url-status=live }}</ref><ref>{{cite book |last1=Ordronaux |first1=John |title=Regimen sanitatis salernitanum. Code of health of the school of Salernum |date=1871 |publisher=Philadelphia, J.B. Lippincott & co. |url=https://archive.org/details/codehealthschoo00salegoog/page/n126/mode/2up}}</ref>

In the 20th century, "melancholia" lost its attachment to abnormal beliefs, and in common usage became entirely a synonym for depression.<ref name="auto"/> Sigmund Freud published a paper on [[Mourning and Melancholia]] in 1918.

In 1907, the German psychiatrist [[Emil Kraepelin]] influentially proposed the existence of a condition he called '[[involutional melancholia]]', which he thought could help explain the more frequent occurrence of depression among elderly people.<ref name=Kendler2020a>{{cite journal |vauthors=Kendler KS, Engstrom EJ |title=Dreyfus and the shift of melancholia in Kraepelin's textbooks from an involutional to a manic-depressive illness |journal=Journal of Affective Disorders |volume=270 |issue= |pages=42–50 |date=2020 |pmid=32275219 |doi=10.1016/j.jad.2020.03.094 |s2cid=215726731 |url=}}</ref> He surmised that in the elderly "the processes of involution in the body are suited to engender mournful or anxious moodiness", though by 1913 he had returned to his earlier view (first expounded in 1899) that age-related depression could be understood in terms of [[History of bipolar disorder|manic-depressive illness]].<ref name=Kendler2020a/>

In 1996, Gordon Parker and Dusan Hadzi-Pavlovic described "melancholia" as a specific disorder of movement and mood.<ref>{{cite book |title=Melancholia: A Disorder of Movement and Mood: A Phenomenological and Neurobiological Review |date=1996 |publisher=Cambridge University Press |location=Sydney |doi=10.1017/CBO9780511759024 |isbn=978-0-521-47275-3 |url=https://www.cambridge.org/core/books/melancholia-a-disorder-of-movement-and-mood/06FCFEFCC319F56F9C2DFD70154652F7 |editor1-last=Parker |editor1-first=Gordon |editor2-first=Dusan |editor2-last=Hadzi-Pavlovic |access-date=2022-08-28 |archive-date=2022-01-20 |archive-url=https://web.archive.org/web/20220120212940/https://www.cambridge.org/core/books/melancholia-a-disorder-of-movement-and-mood/06FCFEFCC319F56F9C2DFD70154652F7 |url-status=live }}</ref> They attached the term to the concept of "endogenous depression" (claimed to be caused by internal forces rather than environmental influences).<ref>{{cite web |last1=Parker |first1=Gordon |title=Back to Black: Why Melancholia Must Be Understood as Distinct from Depression |url=https://theconversation.com/back-to-black-why-melancholia-must-be-understood-as-distinct-from-depression-38025 |website=The Conversation |date=6 September 2015 |language=en |access-date=2022-08-28 |archive-date=2022-03-30 |archive-url=https://web.archive.org/web/20220330205933/https://theconversation.com/back-to-black-why-melancholia-must-be-understood-as-distinct-from-depression-38025 |url-status=live }}</ref>

In 2006, Michael Alan Taylor and Max Fink also defined melancholia as a systemic disorder that could be identified by depressive mood rating scales, verified by the presence of abnormal [[cortisol]] metabolism.<ref name=Taylor2006/> They considered it to be characterized by depressed mood, abnormal motor functions, and abnormal vegetative signs, and they described several forms, including [[retarded depression]], [[psychotic depression]] and [[postpartum depression]].<ref name=Taylor2006>{{cite book |last1=Taylor |first1=Michael Alan |last2=Fink |first2=Max |title=Melancholia: The Diagnosis, Pathophysiology and Treatment of Depressive Illness |date=2006 |publisher=Cambridge University Press |location=New York |isbn=978-0-521-84151-1 |url=https://www.cambridge.org/core/books/melancholia/E6001F6461E25F6DB0598AD736F38C1E |access-date=2022-08-28 |archive-date=2022-05-03 |archive-url=https://web.archive.org/web/20220503102008/https://www.cambridge.org/core/books/melancholia/E6001F6461E25F6DB0598AD736F38C1E |url-status=live }}</ref>

===Melancholic depression===
{{Infobox medical condition
| name            = Melancholic depression
| pronounce       =
| synonyms        =
| image           =File:Accademia - La Meditazione by Domenico Fetti 1618.jpg
| caption         = Meditation by Domenico Fetti 1618
| field           = [[Psychiatry]]
| symptoms        = Low mood, low self-esteem, [[fatigue]], [[insomnia]], [[anorexia (symptom)|anorexia]], [[anhedonia]], lack of mood reactivity
| complications   =[[Self harm]], [[suicide]]
| onset           =Early adulthood
| duration        =
| causes          =[[genetics|Genetic]], environmental, and psychological factors
| risks           = [[Family history (medicine)|Family history]], [[psychological trauma|trauma]]
| diagnosis       =
| differential    =
| prevention      =
| treatment       =[[psychotherapy|Counseling]], [[antidepressant medication]], [[electroconvulsive therapy]]
| medication      =
| prognosis       =
| frequency       =
| deaths          =
|alt=}}
For the purposes of medical [[Classification of mental disorders|diagnostic classification]], the terms "melancholia" and "melancholic" are still in use (for example, in [[ICD-11]] and [[DSM-5]]) to [[Melancholic depression|specify certain features]] that may be present in [[major depression]], referred to as '''depression with melancholic features''' such as:<ref name=":7">World Health Organization, "6A80.3 Current depressive episode with melancholia", International Statistical Classification of Diseases and Related Health Problems, 11th rev. (September 2020).</ref><ref name="DSM-5">{{cite book |author=American Psychiatric Association |author-link=American Psychiatric Association |title=Diagnostic and Statistical Manual of Mental Disorders (DSM-5®) |date=2013 |publisher=American Psychiatric Publishing |location=United States |isbn=978-0-89042-557-2 |page=185 |url=https://books.google.com/books?id=-JivBAAAQBAJ |language=en |access-date=2022-08-28 |archive-date=2021-07-10 |archive-url=https://web.archive.org/web/20210710224318/https://www.google.co.uk/books/edition/Diagnostic_and_Statistical_Manual_of_Men/-JivBAAAQBAJ |url-status=live }}</ref><ref name=apa1>{{Cite book |last=American Psychiatric Association |url=https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890425596 |title=Diagnostic and Statistical Manual of Mental Disorders |date=2013-05-22 |publisher=American Psychiatric Association |isbn=978-0-89042-555-8 |edition=Fifth |language=en |doi=10.1176/appi.books.9780890425596}}</ref>
* severely depressed mood, wherein the person often feels despondent, forlorn, disconsolate, or empty
* pervasive anhedonia – loss of interest or pleasure in most activities that are normally enjoyable
* lack of emotional responsiveness (mood does not brighten, even briefly) to normally pleasurable stimuli (such as food or entertainment) or situations (such as warm, affectionate interactions with friends or family)
* terminal insomnia – unwanted early morning awakening (two or more hours earlier than normal)
* marked psychomotor retardation or agitation
* marked loss of appetite or weight loss

A specifier essentially is a subcategory of a disease, explaining specific features or symptoms that are added to the main diagnosis.<ref>{{Cite web |date=2017-05-17 |title=What's the DSM-5? |url=https://psychcentral.com/lib/dsm-5 |access-date=2023-03-28 |website=Psych Central |language=en}}</ref> According to the [[DSM-IV]], the "melancholic features" specifier may be applied to the following only:
# [[Major depressive episode]], single episode
# [[Major depressive episode]], recurrent episode
# [[Bipolar I disorder]], most recent episode depressed
# [[Bipolar II disorder]], most recent episode depressed
It is important to note, however, that people who suffer from melancholic depression do not need to have melancholic features in every depressive episode.<ref name="psychologytoday.com">{{Cite web |title=The Darkest Mood: Major Depression With Melancholic Features {{!}} Psychology Today |url=https://www.psychologytoday.com/us/blog/and-running/202110/the-darkest-mood-major-depression-melancholic-features |access-date=2023-03-28 |website=www.psychologytoday.com |language=en-US}}</ref>

====Signs and symptoms====
Melancholic depression requires at least one of the following symptoms during the last [[depressive episode]]:
* [[Anhedonia]] (the inability to find pleasure in positive things)
* Lack of mood reactivity (i.e. mood does not improve in response to positive/desired events; failure to feel better)
And at least three of the following:
* [[Depression (mood)|Depressed mood]] that is subjectively different from grief or loss (marked by despair, gloominess, and "empty-mood")
* Severe weight loss or loss of appetite
* Psychomotor agitation or retardation (i.e. increased or decreased movement, speech, and cognitive function)
* Early morning awakening (i.e. waking up at least 2 hours before the normal wake up time of the patient)
* Guilt that is excessive
* Worse depressed mood in the morning
Melancholic features apply to an episode of depression that occurs as part of either [[major depressive disorder]], [[dysthymia|persistent depressive disorder (dysthymia)]], or [[bipolar disorder]] [[Bipolar I disorder|I]] or [[Bipolar II disorder|II]].<ref name="DSM-5"/> They are more likely to occur in patients who suffer from [[Psychotic depression|depression with psychotic features]].<ref name=apa1 /> People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech.<ref name="psychcentral.com">{{Cite web |date=2022-11-03 |title=Melancholic Depression: Symptoms, Diagnosis, Treatment, and Coping Tips |url=https://psychcentral.com/depression/melancholic-depression |access-date=2023-03-28 |website=Psych Central |language=en}}</ref>

====Causes====
The causes of melancholic [[major depressive disorder|depressive disorder]] are believed to be mostly biological factors that can be hereditary. Biological origins of the condition include problems with the [[Hypothalamic–pituitary–adrenal axis|HPA axis]] and [[Sleep architecture|sleep structure]] of patients.<ref name=gp1>{{Cite web |last=Parker |first=Gordon |title=Back to black: why melancholia must be understood as distinct from depression |url=http://theconversation.com/back-to-black-why-melancholia-must-be-understood-as-distinct-from-depression-38025 |access-date=2023-03-28 |website=The Conversation |date=6 September 2015 |language=en}}</ref> [[Magnetic resonance imaging|MRI studies]] have indicated that melancholic depressed patients have issues with the connections between different regions of the brain, specifically the [[Insular cortex|insula]] and [[Frontoparietal network|fronto-parietal cortex]].<ref>{{Cite journal| journal=Psychiatric Times |last=Gordon Parker |first=M. D. |date=2017-01-20 |title=An Update on Melancholia |url=https://www.psychiatrictimes.com/view/update-melancholia |series=Vol 34 No 1 |language=en |volume=34}}</ref> Some studies have found that there are [[Biomarker|biological marker]] differences between patients with melancholic depression and other subtypes of depression.<ref>{{Cite journal |last1=Spanemberg |first1=Lucas |last2=Caldieraro |first2=Marco Antonio |last3=Vares |first3=Edgar Arrua |last4=Wollenhaupt-Aguiar |first4=Bianca |last5=Kauer-Sant'Anna |first5=Márcia |last6=Kawamoto |first6=Sheila Yuri |last7=Galvão |first7=Emily |last8=Parker |first8=Gordon |last9=Fleck |first9=Marcelo P. |date=2014-08-19 |title=Biological differences between melancholic and nonmelancholic depression subtyped by the CORE measure |journal=Neuropsychiatric Disease and Treatment |language=English |volume=10 |pages=1523–1531 |doi=10.2147/NDT.S66504|pmid=25187716 |pmc=4149384 |doi-access=free }}</ref>

The research regarding melancholic depression consistently finds that men are more likely to receive a melancholic depression diagnosis.<ref name=mg1>{{Cite journal |last1=Gili |first1=Margalida |last2=Roca |first2=Miquel |last3=Armengol |first3=Silvia |last4=Asensio |first4=David |last5=Garcia-Campayo |first5=Javier |last6=Parker |first6=Gordon |date=2012-10-26 |title=Clinical Patterns and Treatment Outcome in Patients with Melancholic, Atypical and Non-Melancholic Depressions |journal=PLOS ONE |volume=7 |issue=10 |pages=e48200 |doi=10.1371/journal.pone.0048200 |issn=1932-6203 |pmc=3482206 |pmid=23110213 |bibcode=2012PLoSO...748200G |doi-access=free }}</ref>

====Treatment====
Melancholic depression, due to some fundamental differences with standard clinical depression or other subtypes of depression, has specific types of treatments that work, and the success rates for different treatments can vary.<ref>{{Cite web |date=2022-05-30 |title=What is melancholic depression? Symptoms, diagnosis, and more |url=https://www.medicalnewstoday.com/articles/melancholic-depression |access-date=2023-03-28 |website=www.medicalnewstoday.com |language=en}}</ref><ref name=gp1 /> Treatment can involve [[antidepressants]] and [[Evidence-based practice|empirically supported treatments]] such as [[cognitive behavioral therapy]] and [[interpersonal therapy]] for depression.<ref name="Luty2007">{{Cite journal |last1=Luty |first1=Suzanne |last2=Carter |first2=Janet |last3=McKenzie |first3=Janice |year=2007 |title=Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression |journal=The British Journal of Psychiatry |volume=190 |issue=6 |pages=496–502 |doi=10.1192/bjp.bp.106.024729 |pmid=17541109 |doi-access=free}}
</ref>

Melancholic depression is often considered to be a biologically based and particularly severe form of depression. Therefore, the treatments for this specifier of depression are more biomedical and less psychosocial (which would include talk therapy and social support).<ref name="McGrath 2008">
{{cite journal|last=McGrath|first=Patrick |author2=Ashan Khan |author3=Madhukar Trivedi |author4=Jonathan Stewart |author5=David W Morris |author6=Stephen Wisniewski |author7=Sachiko Miyahara |author8=Andrew Nierenberg |author9=Maurizio Fava |author10=John Rush|title=Response to a Selective Serotonin Reuptake Inhibitor (Citalopram) in Major Depressive Disorder with Melancholic Features: A STAR*D Report|journal=Journal of Clinical Psychiatry|year=2008|volume=69|issue=12 |pages=1847–1855|doi=10.4088/jcp.v69n1201|pmid=19026268 }}</ref> The general initial or "ideal" treatment for melancholic depression is antidepressant medication, and psychotherapy is added later on as support if at all.<ref name="psychologytoday.com"/> The scientific support for medication as the best treatment is that patients with melancholic depression are less likely to improve with placebos, unlike other depression patients. This indicates the improvements observed after medication actually come from the biological basis of the condition and the treatment.<ref name=gp1 /> There are several types of antidepressants that can be prescribed including [[Selective serotonin reuptake inhibitor|SSRIs]], [[Serotonin–norepinephrine reuptake inhibitor|SNRIs]], [[tricyclic antidepressant]]s, and [[Monoamine oxidase inhibitor|MAOIs]]; the antidepressants tend to vary on how they work and what specific [[Neurotransmitter|chemical messengers]] in the brain they target.<ref name="psychcentral.com"/> SNRIs are generally more effective than SSRIs because they target more than one chemical messenger ([[serotonin]] and [[norepinephrine]]).<ref name=mg1 />

Although [[psychotherapy]] treatments can be used such as talk therapy and cognitive behavioral therapy (CBT), they have shown to be less effective than medication.<ref name=gp1/> In a [[Randomized controlled trial|randomized clinical trial]], it was shown that CBT was less effective than medication in treating symptoms of melancholic depression after 12 weeks.<ref>{{Cite journal |last1=Gilfillan |first1=David |last2=Parker |first2=Gordon |last3=Sheppard |first3=Elizabeth |last4=Manicavasagar |first4=Vijaya |last5=Paterson |first5=Amelia |last6=Blanch |first6=Bianca |last7=McCraw |first7=Stacey |date=2014-05-01 |title=Is cognitive behaviour therapy of benefit for melancholic depression? |url=https://www.sciencedirect.com/science/article/pii/S0010440X13003830 |journal=Comprehensive Psychiatry |language=en |volume=55 |issue=4 |pages=856–860 |doi=10.1016/j.comppsych.2013.12.017 |pmid=24461162 |issn=0010-440X}}</ref>

[[Electroconvulsive therapy]] (ECT) was previously believed to be an effective treatment for melancholic depression.<ref>{{Cite journal |last=Rasmussen |first=Keith G. |date=December 2011 |title=Electroconvulsive Therapy and Melancholia: Review of the Literature and Suggestions for Further Study |url=https://journals.lww.com/ectjournal/Abstract/2011/12000/Electroconvulsive_Therapy_and_Melancholia__Review.10.aspx |journal=The Journal of ECT |language=en-US |volume=27 |issue=4 |pages=315–322 |doi=10.1097/YCT.0b013e31820a9482 |pmid=21673591 |issn=1095-0680}}</ref> ECT has been more commonly used for patients with melancholic depression due to the severity. In 2010, a study found that 60% of depression patients treated with ECT had melancholic symptoms.<ref name="psychologytoday.com"/> However, studies since the 2000s have failed to demonstrate positive treatment results from ECT, although studies also indicate a more positive response to ECT in melancholic patients than other depressed patients.<ref name=gp1 /><ref>{{Cite journal |last1=Rush |first1=Gavin |last2=O'Donovan |first2=Aoife |last3=Nagle |first3=Laura |last4=Conway |first4=Catherine |last5=McCrohan |first5=AnnMaria |author6-link=Cliona O'Farrelly |last6=O'Farrelly |first6=Cliona |last7=Lucey |first7=James V. |last8=Malone |first8=Kevin M. |date=2016-11-15 |title=Alteration of immune markers in a group of melancholic depressed patients and their response to electroconvulsive therapy |journal=Journal of Affective Disorders |language=en |volume=205 |pages=60–68 |doi=10.1016/j.jad.2016.06.035 |issn=0165-0327 |pmc=5291160 |pmid=27414954}}</ref>

It has been observed in studies that patients with melancholic depression tend to recover less often than other types of depression.<ref name=mg1 />

====Frequency====
The prevalence of having the melancholic depression specifier among patients diagnosed with clinical depression is estimated to be about 25% to 30%.<ref name="psychologytoday.com"/>

The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.<ref name="radua2010">
{{Cite journal
 | last1 = Radua | first1 = Joaquim
 | last2 = Pertusa | first2 = Alberto
 | last3 = Cardoner | first3 = Narcis
 | title = Climatic relationships with specific clinical subtypes of depression
 | journal = Psychiatry Research
 | volume = 175
 | issue = 3
 | pages = 217–220
 | date = 28 February 2010
 | doi = 10.1016/j.psychres.2008.10.025
 | pmid = 20045197
| s2cid = 21764662
 }}
</ref>