Melancholia

File:Albrecht Dürer - Melencolia I - Google Art Project ( AGDdr3EHmNGyA).jpg by Albrecht Dürer, 1514]]

File:Robert Burton's Anatomy of Melancholy, 1626, 2nd edition.jpg for the 1628 3rd edition of The Anatomy of Melancholy]]

The name "melancholia" comes from the old medical belief of the four humours: disease or ailment being caused by an imbalance in one or more of the four basic bodily liquids, or humours. Personality types were similarly determined by the dominant humor in a particular person. According to Hippocrates and subsequent tradition, melancholia was caused by an excess of black bile,Hippocrates, [https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0251%3Atext%3DAer.%3Asection%3D10 De aere aquis et locis, 10.103] {{Webarchive|url=https://web.archive.org/web/20220601220934/https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.01.0251%3Atext%3DAer.%3Asection%3D10 |date=2022-06-01 }}, on Perseus Digital Library hence the name, which means "black bile", from Ancient Greek μέλας ({{Transliteration|grc|melas}}), "dark, black",[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dme%2Flas μέλας] {{Webarchive|url=https://web.archive.org/web/20110605183904/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dme%2Flas |date=2011-06-05 }},

Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus Digital Library and χολή ({{Transliteration|grc|kholé}}), "bile";[https://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dxolh%2F χολή] {{Webarchive|url=https://web.archive.org/web/20220708042944/http://www.perseus.tufts.edu/hopper/text?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3Dxolh%2F |date=2022-07-08 }}, Henry George Liddell, Robert Scott, A Greek–English Lexicon, on Perseus Digital Library a person whose constitution tended to have a preponderance of black bile had a melancholic disposition. In the complex elaboration of humorist theory, it was associated with the earth from the Four Elements, the season of autumn, the spleen as the originating organ and cold and dry as related qualities. In astrology it showed the influence of Saturn, hence the related adjective saturnine.

Melancholia was described as a distinct disease with particular mental and physical symptoms in the 5th and 4th centuries BC. Hippocrates, in his Aphorisms, characterized all "fears and despondencies, if they last a long time" as being symptomatic of melancholia.Hippocrates, Aphorisms, Section 6.23 Other symptoms mentioned by Hippocrates include: poor appetite, abulia, sleeplessness, irritability, agitation.Epidemics, III, 16 cases, case II The Hippocratic clinical description of melancholia shows significant overlaps with contemporary nosography of depressive syndromes (6 symptoms out of the 9 included in DSM American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. APA, Washington DC., pp. 160–161. diagnostic criteria for a Major Depressive).{{Cite book |last=Azzone |first=Paolo |url=https://www.worldcat.org/title/816563937 |title=Depression as a psychoanalytic problem |date=2013 |publisher=University Press of America |isbn=978-0-7618-6041-9 |location=Lanham, Md |oclc=816563937}}

In ancient Rome, Galen added "fixed delusions" to the set of symptoms listed by Hippocrates. Galen also believed that melancholia caused cancer.{{cite book|url= https://books.google.com/books?id=oI6LtxfEKkwC&q=melancholia+%22gall+bladder%22&pg=PA322|title= Coffee: Physiology|first1= R. J.|last1= Clarke|first2= R.|last2= Macrae|year= 1988|publisher= Springer Science & Business Media|via= Google Books|isbn= 978-1-85166-186-2|access-date= 2022-08-28|archive-date= 2022-07-03|archive-url= https://web.archive.org/web/20220703235357/https://books.google.com/books?id=oI6LtxfEKkwC&q=melancholia+%22gall+bladder%22&pg=PA322|url-status= live}} Aretaeus of Cappadocia, in turn, believed that melancholia involved both a state of anguish, and a delusion. In the 10th century Persian physician Al-Akhawayni Bokhari described melancholia as a chronic illness caused by the impact of black bile on the brain.{{cite journal|last1=Delfaridi|first1=Behnam|title=Melancholia in Medieval Persian Literature: The View of Hidayat of Al-Akhawayni.|journal=World Journal of Psychiatry|date=2014|pages=37–41|doi=10.5498/wjp.v4.i2.37|volume=4|issue=2|pmc=4087154|pmid=25019055 |doi-access=free }} He described melancholia's initial clinical manifestations as "suffering from an unexplained fear, inability to answer questions or providing false answers, self-laughing and self-crying and speaking meaninglessly, yet with no fever."{{cite book |last=Matini |first=Jalal|title= Hedayat al-Motaallemin fi Tebb |publisher= University Press, Mashhad |year= 1965 }}

In Middle-Ages Europe, the humoral, somatic paradigm for understanding sustained sadness lost primacy in front of the prevailing religious perspective.Azzone P. (2013) pp. 23ff.Azzone P (2012) Sin of Sadness: Acedia vel Tristitia Between Sociocultural Conditioning and Psychological Dynamics of Negative Emotions. Journal of Psychology and Christianity, 31: 50–64. Sadness came to be a vice (λύπη in the Greek vice list by Evagrius Ponticus,Guillamont A., Guillamont C. (Eds.) (1971) Évagre le Pontique. Traité pratique ou le moine, 2 VV.. Sources Chrétiennes 170–171, Les Éditions du Cerf, Paris tristitia vel acidia in the 7 vice list by Pope Gregory I).Gregorius Magnus. Moralia in Iob. In J.-P. Migne (Ed.) Patrologiae Latinae cursus completus (Vol. 75, col. 509D – Vol. 76, col. 782AG) When a patient could not be cured of the disease it was thought that the melancholia was a result of demonic possession.{{cite web|url=http://loki.stockton.edu/~kinsellt/projects/pom/storyReader$7.html|title=18th-Century Theories of Melancholy & Hypochondria|website=loki.stockton.edu|access-date=2022-08-28|archive-date=2021-01-25|archive-url=https://web.archive.org/web/20210125034701/http://loki.stockton.edu/~kinsellt/projects/pom/storyReader$7.html|url-status=live}}Farmer, Hugh. [https://archive.org/stream/essayondemonia00farm#page/56/mode/2up An essay on demoniacs of the New Testament] 56 (1818)

In his study of French and Burgundian courtly culture, Johan HuizingaHuizinga, "Pessimism and the ideal of the sublime life", The Waning of the Middle Ages, 1924:22ff. noted that "at the close of the Middle Ages, a sombre melancholy weighs on people's souls." In chronicles, poems, sermons, even in legal documents, an immense sadness, a note of despair and a fashionable sense of suffering and deliquescence at the approaching end of times, suffuses court poets and chroniclers alike: Huizinga quotes instances in the ballads of Eustache Deschamps, "monotonous and gloomy variations of the same dismal theme", and in Georges Chastellain's prologue to his Burgundian chronicle,"I, man of sadness, born in an eclipse of darkness, and thick fogs of lamentation". and in the late 15th-century poetry of Jean Meschinot. Ideas of reflection and the workings of imagination are blended in the term merencolie, embodying for contemporaries "a tendency", observes Huizinga, "to identify all serious occupation of the mind with sadness".Huizinga 1924:25.

Painters were considered by Vasari and other writers to be especially prone to melancholy by the nature of their work, sometimes with good effects for their art in increased sensitivity and use of fantasy. Among those of his contemporaries so characterised by Vasari were Pontormo and Parmigianino, but he does not use the term of Michelangelo, who used it, perhaps not very seriously, of himself.Britton, Piers, "Mio malinchonico, o vero... mio pazzo": Michelangelo, Vasari, and the Problem of Artists' Melancholy in Sixteenth-Century Italy, The Sixteenth Century Journal, Vol. 34, No. 3 (Fall, 2003), pp. 653–675, {{doi|10.2307/20061528}}, {{Webarchive|url=https://web.archive.org/web/20201114100118/https://www.jstor.org/stable/20061528 |date=2020-11-14 }} A famous allegorical engraving by Albrecht Dürer is entitled Melencolia I. This engraving has been interpreted as portraying melancholia as the state of waiting for inspiration to strike, and not necessarily as a depressive affliction. Amongst other allegorical symbols, the picture includes a magic square and a truncated rhombohedron.{{cite web|url=http://mathworld.wolfram.com/DuerersSolid.html|title=Dürer's Solid|first=Eric W.|last=Weisstein|website=mathworld.wolfram.com|access-date=2022-08-28|archive-date=2022-01-30|archive-url=https://web.archive.org/web/20220130210426/https://mathworld.wolfram.com/DuerersSolid.html|url-status=live}} The image in turn inspired a passage in The City of Dreadful Night by James Thomson (B.V.), and, a few years later, a sonnet by Edward Dowden.

The most extended treatment of melancholia comes from Robert Burton, whose The Anatomy of Melancholy (1621) treats the subject from both a literary and a medical perspective. His concept of melancholia includes all mental illness, which he divides into different types. Burton wrote in the 17th century that music and dance were critical in treating mental illness.Cf. The Anatomy of Melancholy, subsection 3, on and after line 3480, "Music a Remedy":

{{blockquote|But to leave all declamatory speeches in praise of divine music, I will confine myself to my proper subject: besides that excellent power it hath to expel many other diseases, it is a sovereign remedy against despair and melancholy, and will drive away the devil himself. Canus, a Rhodian fiddler, in Philostratus, when Apollonius was inquisitive to know what he could do with his pipe, told him, "That he would make a melancholy man merry, and him that was merry much merrier than before, a lover more enamoured, a religious man more devout." Ismenias the Theban, Chiron the centaur, is said to have cured this and many other diseases by music alone: as now they do those, saith Bodine, that are troubled with St. Vitus's Bedlam dance.{{Cite web|url=http://www.gutenberg.org/files/10800/10800-8.txt|title=Gutenberg.org|access-date=2022-08-28|archive-date=2020-08-09|archive-url=https://web.archive.org/web/20200809183107/https://www.gutenberg.org/files/10800/10800-8.txt|url-status=live}}[http://www.med.mun.ca/munmed/84/crellin.htm "Humanities are the Hormones: A Tarantella Comes to Newfoundland. What should we do about it?"] {{webarchive |url=https://web.archive.org/web/20150215015105/http://www.med.mun.ca/munmed/84/crellin.htm |date=February 15, 2015 }} by Dr. John Crellin, Munmed, newsletter of the Faculty of Medicine, Memorial University of Newfoundland, 1996.{{Cite journal|author1=Aung, Steven K.H. |author2=Lee, Mathew H.M. |title=Music, Sounds, Medicine, and Meditation: An Integrative Approach to the Healing Arts |journal=Alternative & Complementary Therapies |year=2004 |volume=10 |issue=5 |pages=266–270 |doi=10.1089/act.2004.10.266}}}}

In the Encyclopédie of Diderot and d'Alembert, the causes of melancholia are stated to be similar to those that cause Mania: "grief, pains of the spirit, passions, as well as all the love and sexual appetites that go unsatisfied."{{cite journal |author=Denis Diderot |title= Melancholia |url= http://quod.lib.umich.edu/d/did/did2222.0000.808/--melancholia?rgn=main;view=fulltext |date= 2015 |journal= The Encyclopedia of Diderot & d'Alembert Collaborative Translation Project |access-date= 1 April 2015 |archive-date= 2 April 2015 |archive-url= https://web.archive.org/web/20150402215527/http://quod.lib.umich.edu/d/did/did2222.0000.808/--melancholia?rgn=main;view=fulltext |url-status= live }}

File:Ch. Boirau, "The Spleen" ("Melancholy").jpg

File:John Donne BBC News.jpg, the very picture of fashionable melancholy in the Jacobean era]]

File:Melancholy-Castiglione.jpg by Giovanni Benedetto Castiglione, 1640s]]

During the later 16th and early 17th centuries, a curious cultural and literary cult of melancholia arose in England. In an influential{{Cite journal |last=Goldring |first=Elizabeth |date=2005 |title='So lively a portraiture of his miseries': Melancholy, mourning and the Elizabethan malady |url=https://www.jstor.org/stable/41614620 |journal=The British Art Journal |volume=6 |issue=2 |pages=12–22 |jstor=41614620 |issn=1467-2006 |url-access=registration}}{{cite book | last = Ribeiro | first = Aileen | title = Fashion and Fiction: Dress in Art and Literature in Stuart England | publisher = Yale University Press | location = New Haven CN; London | year = 2005 | isbn = 978-0-300-10999-3|page=52}} 1964 essay in Apollo, art historian Roy Strong traced the origins of this fashionable melancholy to the thought of the popular Neoplatonist and humanist Marsilio Ficino (1433–1499), who replaced the medieval notion of melancholia with something new: {{blockquote|Ficino transformed what had hitherto been regarded as the most calamitous of all the humours into the mark of genius. Small wonder that eventually the attitudes of melancholy soon became an indispensable adjunct to all those with artistic or intellectual pretentions.{{cite journal|last=Strong|first=Roy|year=1964|title=The Elizabethan Malady: Melancholy in Elizabeth and Jacobean Portraiture|journal=Apollo|volume=LXXIX}}, reprinted in {{cite book | last = Strong | first = Roy | title = The English Icon: Elizabethan and Jacobean Portraiture | publisher = Routledge & Kegan Paul | location = London | year = 1969}}}}

The Anatomy of Melancholy (The Anatomy of Melancholy, What it is: With all the Kinds, Causes, Symptomes, Prognostickes, and Several Cures of it... Philosophically, Medicinally, Historically, Opened and Cut Up) by Burton, was first published in 1621 and remains a defining literary monument to the fashion. Another major English author who made extensive expression upon being of an melancholic disposition is Sir Thomas Browne in his Religio Medici (1643).

Night-Thoughts (The Complaint: or, Night-Thoughts on Life, Death, & Immortality), a long poem in blank verse by Edward Young was published in nine parts (or "nights") between 1742 and 1745, and hugely popular in several languages. It had a considerable influence on early Romantics in England, France and Germany. William Blake was commissioned to illustrate a later edition.

In the visual arts, this fashionable intellectual melancholy occurs frequently in portraiture of the era, with sitters posed in the form of "the lover, with his crossed arms and floppy hat over his eyes, and the scholar, sitting with his head resting on his hand"{{snd}}descriptions drawn from the frontispiece to the 1638 edition of Burton's Anatomy, which shows just such by-then stock characters. These portraits were often set out of doors where Nature provides "the most suitable background for spiritual contemplation"{{cite book | last = Ribeiro | first = Aileen | title = Fashion and Fiction: Dress in Art and Literature in Stuart England | publisher = Yale University Press | location = New Haven, CN; London | year = 2005 | isbn = 978-0-300-10999-3|page=54 }} or in a gloomy interior.

In music, the post-Elizabethan cult of melancholia is associated with John Dowland, whose motto was Semper Dowland, semper dolens ("Always Dowland, always mourning"). The melancholy man, known to contemporaries as a "malcontent", is epitomized by Shakespeare's Prince Hamlet, the "Melancholy Dane".

A similar phenomenon, though not under the same name, occurred during the German Sturm und Drang movement, with such works as The Sorrows of Young Werther by Goethe or in Romanticism with works such as Ode on Melancholy by John Keats or in Symbolism with works such as Isle of the Dead by Arnold Böcklin. In the 20th century, much of the counterculture of modernism was fueled by comparable alienation and a sense of purposelessness called "anomie"; earlier artistic preoccupation with death has gone under the rubric of memento mori. The medieval condition of acedia (acedie in English) and the Romantic Weltschmerz were similar concepts, most likely to affect the intellectual.Perpinyà, Núria (2014). [http://www.logos-verlag.de/cgi-bin/buch/isbn/3794 Ruins, Nostalgia and Ugliness. Five Romantic Perceptions of Middle Ages and a Spoon of Game of Thrones and Avant-Garde Oddity] {{Webarchive|url=https://web.archive.org/web/20160313091643/http://logos-verlag.de/cgi-bin/buch/isbn/3794 |date=2016-03-13 }}. Berlin: Logos Verlag

Until the 18th century, writings on melancholia were mainly concerned with beliefs that were considered abnormal, rather than affective symptoms.{{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 }}

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."{{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 }}{{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}}

In the 20th century, "melancholia" lost its attachment to abnormal beliefs, and in common usage became entirely a synonym for depression. 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.{{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=}} 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 manic-depressive illness.

In 1996, Gordon Parker and Dusan Hadzi-Pavlovic described "melancholia" as a specific disorder of movement and mood.{{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 }} They attached the term to the concept of "endogenous depression" (claimed to be caused by internal forces rather than environmental influences).{{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 }}

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. 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.{{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 }}

{{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, anhedonia, lack of mood reactivity

| complications =Self harm, suicide

| onset =Early adulthood

| duration =

| causes =Genetic, environmental, and psychological factors

| risks = Family history, trauma

| diagnosis =

| differential =

| prevention =

| treatment =Counseling, antidepressant medication, electroconvulsive therapy

| medication =

| prognosis =

| frequency =

| deaths =

|alt=}}

For the purposes of medical diagnostic classification, the terms "melancholia" and "melancholic" are still in use (for example, in ICD-11 and DSM-5) to specify certain features that may be present in major depression, referred to as depression with melancholic features such as:World Health Organization, "6A80.3 Current depressive episode with melancholia", International Statistical Classification of Diseases and Related Health Problems, 11th rev. (September 2020).{{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 }}{{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}}

• 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.{{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}} According to the DSM-IV, the "melancholic features" specifier may be applied to the following only:

1. Major depressive episode, single episode
2. Major depressive episode, recurrent episode
3. Bipolar I disorder, most recent episode depressed
4. 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.{{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}}

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:

• 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, persistent depressive disorder (dysthymia), or bipolar disorder I or II. They are more likely to occur in patients who suffer from depression with psychotic features. People with melancholic depression also tend to have more physically visible symptoms such as slower movement or speech.{{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}}

The causes of melancholic depressive disorder are believed to be mostly biological factors that can be hereditary. Biological origins of the condition include problems with the HPA axis and sleep structure of patients.{{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}} MRI studies have indicated that melancholic depressed patients have issues with the connections between different regions of the brain, specifically the insula and fronto-parietal cortex.{{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}} Some studies have found that there are biological marker differences between patients with melancholic depression and other subtypes of depression.{{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 }}

The research regarding melancholic depression consistently finds that men are more likely to receive a melancholic depression diagnosis.{{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 }}

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.{{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}} Treatment can involve antidepressants and empirically supported treatments such as cognitive behavioral therapy and interpersonal therapy for depression.{{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}}

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).

{{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 }} The general initial or "ideal" treatment for melancholic depression is antidepressant medication, and psychotherapy is added later on as support if at all. 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. There are several types of antidepressants that can be prescribed including SSRIs, SNRIs, tricyclic antidepressants, and MAOIs; the antidepressants tend to vary on how they work and what specific chemical messengers in the brain they target. SNRIs are generally more effective than SSRIs because they target more than one chemical messenger (serotonin and norepinephrine).

Although psychotherapy treatments can be used such as talk therapy and cognitive behavioral therapy (CBT), they have shown to be less effective than medication. In a randomized clinical trial, it was shown that CBT was less effective than medication in treating symptoms of melancholic depression after 12 weeks.{{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|url-access=subscription }}

Electroconvulsive therapy (ECT) was previously believed to be an effective treatment for melancholic depression.{{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|url-access=subscription }} 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. 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.{{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}}

It has been observed in studies that patients with melancholic depression tend to recover less often than other types of depression.

The prevalence of having the melancholic depression specifier among patients diagnosed with clinical depression is estimated to be about 25% to 30%.

The incidence of melancholic depression has been found to increase when the temperature and/or sunlight are low.

{{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

}}

{{Portal|Psychology}}

{{Div col}}

• Boredom
• Dysthymia
• Got the morbs
• Melancholic depression
• Mono no aware
• Nostalgia
• Pessimism
• Saudade
• Spleen
• Vapours (disease)
• Wit and Mirth, or Pills to Purge Melancholy

{{Div col end}}

{{Reflist}}

{{refbegin|40em}}

• Azzone, Paolo: Depression as a Psychoanalytic Problem. University Press of America, Lanham, Md., 2013. {{ISBN|978-0-761-86041-9}}
• {{cite web |title=New BBC Radio Series: The Anatomy of Melancholy – Department of Psychiatry |url=https://www.psych.ox.ac.uk/news/new-bbc-radio-series-the-anatomy-of-melancholy |website=www.psych.ox.ac.uk |access-date=2022-08-28 |archive-date=2022-05-11 |archive-url=https://web.archive.org/web/20220511021948/https://www.psych.ox.ac.uk/news/new-bbc-radio-series-the-anatomy-of-melancholy |url-status=live }}, a twelve part series titled The New Anatomy of Melancholy, looking at depression from the perspectives of Robert Burton's 1621 book The Anatomy of Melancholy
• Blazer, Dan G.: The Age of Melancholy: "Major Depression" and its Social Origin. Routledge, 2005. {{ISBN|978-0-415-95188-3}}
• Bowring, Jacky: A Field Guide to Melancholy. Oldcastle Books, 2009. {{ISBN|978-1-842-43292-1}}
• Boym, Svetlana: The Future of Nostalgia. Basic Books, 2002. {{ISBN|978-0-465-00708-0}}
• Jackson, Stanley W.: Melancholia and Depression: From Hippocratic Times to Modern Times. Yale University Press, 1986. {{ISBN|978-0-300-03700-5}}
• Klibansky, Raymond; Panofsky, Erwin; Saxl, Fritz: Saturn and Melancholy: Studies in the History of Natural Philosophy, Religion, and Art. McGill-Queen's Press, 1964 [2019] {{ISBN|978-0-7735-5952-3}}
• Kristeva, Julia: Black Sun. Columbia University Press, 1992. {{ISBN|978-0-231-06707-2}}
• Radden, Jennifer: The Nature of Melancholy: From Aristotle to Kristeva. Oxford University Press, 2002. {{ISBN|978-0-195-15165-7}}
• Schwenger, Peter: The Tears of Things: Melancholy and Physical Objects. University of Minnesota Press, 2006. {{ISBN|978-0-816-64631-9}}
• Shenk, Joshua W.: Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness. Mariner Books, 2006. {{ISBN|978-0-618-77344-2}}
• Various: Melancholy Experience in Literature of the Long Eighteenth Century. Palgrave Macmillan, 2011. {{ISBN|978-1-349-31949-7}}

{{refend}}

{{Commons category}}

{{wiktionary}}

• [https://web.archive.org/web/20040625212125/http://www2.hammer.ucla.edu/etc/durer/ Grunwald Center website: Durer's Melencolia and clinical depression, iconography and printmaking techniques]
• [http://www.theotherpages.org/poems/2000/d/dowden53.html "Dürer's Melancholia": sonnet by Edward Dowden]
• [http://www.signandsight.com/features/710.html Melancholy and abstraction], on the Berlin exhibition "Melancholy: Genius and Madness in Art"
• [http://hdl.handle.net/2027/spo.did2222.0000.808 Diderot's historic writing on Melancholy]
• [https://www.bbc.co.uk/sounds/play/b008h5dz "The Four Humours" on "In Our Time"]
• [https://www.bbc.co.uk/sounds/play/b010y30m "An Anatomy of Melancholy" on "In Our Time"]
• [https://brill.com/view/book/9789004232549/B9789004232549-s013.xml At the Roots of Melancholy]

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{{Mental and behavioral disorders|selected = mood}}

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