Editing Melancholia (section)

====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}}
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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 />