Psycho-Babble Medication Thread 31524

Shown: posts 1 to 9 of 9. This is the beginning of the thread.

 

Melancholia

Posted by Ginny on April 27, 2000, at 20:51:48

What is melancholia? Is there any difference between melancholia and depression?

 

Re: Melancholia

Posted by Greg on April 28, 2000, at 14:27:47

In reply to Melancholia, posted by Ginny on April 27, 2000, at 20:51:48

Ginny,
While melancholia and depression are similar in effect, melancholia is believed to be passed from generation to generation, while depression is not necessarily hereditary.

I'm including a passage from a book written in 1621 called "The Anatomy of Melancholy" by Robert Burton.

"That ...inbred cause of Melancholy is our Temperament, in whole or part, which we receive from our parents...it being a hereditary disease; such as the temperament of the father is, such is the son's, and look what disease the father had when he begot him, his son will have after him...And that which is more to be wondered at, it skips in some families the father, and goes to the son, or takes every other, and sometimes every third in a lineal descent, and doth not always produce the same, but some like, and a symbolizing disease..."

Hope this helps.

Greg

> What is melancholia? Is there any difference between melancholia and depression?

 

Re: Melancholia

Posted by JohnL on April 29, 2000, at 5:15:16

In reply to Melancholia, posted by Ginny on April 27, 2000, at 20:51:48

> What is melancholia? Is there any difference between melancholia and depression?

I'm not sure of the technical textbook differences here. But in my mind, melancholia is a form of depression characterized by being chronic in nature, and having emphasis on symptoms of anhedonia and overall gloominess. With melancholia, the person is able to function, but doesn't really live or enjoy anything.
JohnL

 

Re: Melancholia

Posted by AndrewB on April 29, 2000, at 9:13:37

In reply to Re: Melancholia, posted by JohnL on April 29, 2000, at 5:15:16

There is a type of depression that is called melancholic depressioin. Its diagnostic criteria are as follows:

A. Either of the following:

1.Anhedonia (inability to experience pleasure)
2.Inability to temporarily feel better in response to pleasurable stimuli

B. Three or more of the following:

1.Depressed mood distinctly different from sadness or grief
2.Depression worse in morning
3.Early morning awakening
4.Marked observed psychomotor agitation or retardation
5.Significant anorexia or weight loss
6.Excessive or inappropriate guilt

 

Yo, AndrewB!

Posted by Ginny on April 29, 2000, at 10:03:02

In reply to Re: Melancholia, posted by AndrewB on April 29, 2000, at 9:13:37

Thanks for that. I'm after more. Did you get your information out of a diagnostic manual? Robert Burton notwithstanding, what I'm after is the significance of a diagnosis of melancholia. How is it different from garden-variety unipolar depression? What does it mean to a psychiatrist? How is it treated differently? In my boning up on depression, I've occasionally seen reference to melancholia as a specific diagnosis, but I've never known what it meant. For example, there was a post on the topic of a psychiatrist's diagnostic and treatment algorithm, which algorithm leads to a diagnosis of melancholia as a particular type of depression.

Just wondering. It may be a distinction without a difference to a depressed person, but I think it is a term of art to a psychiatrist with ramifacations as to prognosis and a course of treatment.

Thanks for responding.

 

Re: Yo, AndrewB!

Posted by AndrewB on April 29, 2000, at 10:35:06

In reply to Yo, AndrewB!, posted by Ginny on April 29, 2000, at 10:03:02

I can't answer your question but I can tell you where to look. Do a search using the Google search engine. Use the keywords 'melancholic depression' and 'antidepressant' or 'treatment'.

Best of luck,

AndrewB

 

Re: Yo, AndrewB!

Posted by Scott L. Schofield on April 29, 2000, at 11:46:24

In reply to Yo, AndrewB!, posted by Ginny on April 29, 2000, at 10:03:02

> Just wondering. It may be a distinction without a difference to a depressed person, but I think it is a term of art to a psychiatrist with ramifacations as to prognosis and a course of treatment.

Yes.


Dear Ginny,

I would first look at the diagnostic criteria posted by AndrewB. I am always admiring of his care for others and the accuracy and detail contained in his compositions.

There are constructive reasons for discriminating between the different types of depressions (presentations). They can be differentially responsive to treatments.

Melancholia is the term first used to describe depression. The term "endogenous" was later used to substitute for it. I think "endogenous" was chosen so as to put forth the idea that this depression seemed to be generated from within the body, and was not dependant upon what was happening outside of it. The term "unipolar" was later added to delineate it from "bipolar" (substituted for "manic-depression"). The majority of presentations of major depression (unipolar depression) is of the "endogenous" or "melancholic" type. Melancholic features were "typical" in diagnosed cases of unipolar depression. However, it became apparent that a minority percentage of cases were presenting with characteristics opposite to those of the majority. Vegetative symptoms were reversed. These depressions were "atypical".


Melancholic: unreactive; inability to respond stimuli.
Atypical: reactive; ability to respond to stimuli - smile, laugh

Melancholic: depression worse in morning
Atypical: depression worse in evening

Melancholic: insomnia; early morning awakening
Atypical: hypersomnia; sleeping too late

Melancholic: agitation
Atypical: anergia; lack of energy

Melancholic: anorexia or weight loss
Atypical: increased appetite or weight gain.


Melancholics have been shown to be more responsive to tricyclic antidepressants. Atypicals have been shown to be more responsive to MAO-inhibitors.

I really don't know enough about how these two types of depression respond to the other drugs. I'm sure someone does. If I have time, I will look into it. I think melancholic and psychotic depressions are more responsive to ECT.

I once met a SEVERELY depressed melancholic. She walked like an elderly woman and was as feeble. Her facial expression was fixed. It was excruciating to watch her fetch me a piece of paper-toweling. Each step taken was a monumental chore. I was horrified. She later committed suicide. I get the feeling that the great majority of depressed individuals participating on this board are atypicals. I may be wrong. If this is the case, though, I can certainly understand why.


- Scott

 

Re: Melancholia

Posted by ginny on May 1, 2000, at 16:33:10

In reply to Melancholia, posted by Ginny on April 27, 2000, at 20:51:48

> What is melancholia? Is there any difference between melancholia and depression?

There may not be another human being on this board interested in this topic, but here are a couple of paragraphs ripped from the Merck Manual on the topic of melancholia versus atypical depression. I had thought that maybe melancholia is a particularly crippling subcategory of depression, but I conclude from this reading that melancholia is garden variety unipolar depression with no obvious external cause.

Incidentally, does anyone know where a connoisseur of wretchedness could find a DSM IV on the web?

Anyhow, here is the Merck murk:

Melancholia (formerly endogenous depression) has a qualitatively distinct clinical picture, characterized by marked psychomotor slowing (of thinking and activity) or agitation (eg, restlessness, wringing of the hands, pressure of speech), weight loss, irrational guilt, and loss of the capacity to experience pleasure. Mood and activity vary diurnally, with a nadir in the morning. Most melancholic patients complain of difficulty falling asleep, multiple arousals, and insomnia in the middle of the night or early morning. Sexual desire is often diminished or lost. Amenorrhea can occur. Anorexia and weight loss may lead to emaciation and secondary disturbances in electrolyte balance.

In atypical depression, reverse vegetative features dominate the clinical presentation; they include anxious-phobic symptoms, evening worsening, initial insomnia, hypersomnia that often extends into the day, and hyperphagia with weight gain. Unlike patients with melancholia, those with atypical depression show mood brightening to potentially positive events but often crash into a paralyzing depression with the slightest adversity. Atypical depressive and bipolar II disorders overlap considerably.

 

Quel est melancholia?

Posted by ginny on May 2, 2000, at 15:06:50

In reply to Melancholia, posted by Ginny on April 27, 2000, at 20:51:48

Melancholia (autrefois dépression endogène) a une image clinique qualitativement distincte, charactérisée par le ralentissement psychomoteur marqué (de la pensée et de l'activité) ou l'agitation (par exemple, restlessness, extorsion des mains, pression de la parole), la perte de poids, la culpabilité irrationnelle, et la perte de la capacité d'éprouver le plaisir. L'humeur et l'activité changent journalier, avec un nadir le matin. La plupart des patients melancholic se plaignent de la difficulté tombant des arousals en sommeil et multiples, et insomnie au milieu de la nuit ou du matin tôt. Le désir sexuel est souvent diminué ou détruit. Amenorrhea peut se produire. Anorexia et perte de poids peuvent mener à l'emaciation et les perturbations secondaires dans l'électrolyte équilibrent.


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