What are the symptoms of melancholia?

Melancholia is one of the great words in psychiatry. It is a depressed state of the entire personality reaction. Depression is spirits, psychomotor retardation and general torpidity of mind and body are its essential feature.

In addition to terminal insomnia and anorexia, people with melancholia complain of other symptoms. One is a pervasive loss interest or pleasure, including a subjective sense that their change in mood is different from normal.

Another indicator of melancholia is a change in mood state during the day, with a tendency to feel worse in the morning and better as the day goes on. There can be implicit anxiety, but more often apathy gives the depression its characteristics form.

Other symptoms of melancholia include excessive guilt and severe psychomotor retardation or agitation. In pure melancholia, inhibition never reaches stupor. Also speech pattern, a monotonous and voice, slowing down of all movements, poverty of expressive movements, all these characterize melancholic inhibition.

The feeling of inadequacy, or insufficiency is yet another very important symptom of pure melancholia.

Melancholics wake up early in the morning – roughly 2 or 3 hours earlier than normal. On waking, until the afternoon, they feel worried and anxious. Heavy sprits are unable to be diverted by external positive stimuli.
What are the symptoms of melancholia?

DSM-111-R Criteria for Melancholia

DSM-111-R Criteria for Melancholia The presence of at least five of the following:

1. Loss of the interest or pleasure in all or almost all activities.
2. Lack of reactivity to usually pleasurable stimuli (does not feel much better even temporarily, when something good happens).
3. Depression regularly worse in the morning.
4. Early morning awaking (at least two hours before usually time).
5. Psychomotor retardation or agitation (not merely subjective complaints).
6. Significant anorexia or weight lost (e.g., more than 5% of body weight in a month).
7. No significant personally disturbance before fist major depressive episode.
8. One or more previous major depressives episodes followed by a complete, or early complete recovery.
9. Previous good response to specific and adequate somatic antidepressant therapy.

DSM-111-R Criteria for Melancholia

Endogenous/Melancholic Depression

Endogenous/Melancholic Depression
Within the heterogenous profile of depression, it has always been assumed that endogenous depression was likely to be closest to a disease entity.

Consequently, the investigation of endogenous/melancholic depression and its distinction from other sub-types have been a main focus for studies of symptom variation.

While neurotic depressions are often regarded as milder states of heterogenous nature and course, it has been assumed that endogenous depression is somehow one thing or (core) entity and that careful description associated with a variety of statistical and other techniques will illuminate it.

An early set of criteria for identifying endogenous depression was developed by the Newcastle group and other research criteria.

The Newcastle scale assigns various weights to different symptoms due to the idea that these symptoms were associated with good outcome.

Since the advent of the Newcastle scale, other classifications have appeared. The most well known being the DSM-111-R criteria for melancholia.

Unlike the Newcastle endogenous depression scale, symptoms of melancholia (DSM-111-R) are not given weights.

Thus the idea of a hierarchy of symptoms (i.e. some symptoms are more keys or core) is not found here.
Endogenous/Melancholic Depression

Description of Depression

Description of Depression
The condition that today we label depression has been described by a number of ancient writers under classification of “melancholia.” The first clinical description of melancholia was made by Hippocrates in the 4th century B.C. He also referred to swings similar to mania and depression.

Aretaeus, physician living in the 2nd century, A.D described the melancholic patient as “sad, dismayed, sleepless…They become this by their agitation and loss of refreshing sleep…At more advanced stage, they complain of a thousand futilities and desire death.” It is noteworthy that Aretaeus specifically delineated the manic-depressive cycle. Some authorities believe that he anticipated the Kraepelinian synthesis of manic depressive psychosis.

Pinel at the beginning of the nineteenth century described melancholia as follows:
“The symptoms generally comprehend by the term melancholia are taciturnity, a thoughtful pensive air, gloomy suspicious and a love of solitude. Those traits, indeed, appear to distinguish the characters of some men otherwise in good health, and frequently in prosperous circumstances. Nothing, however, can be more hideous than the figure of a melancholic brooding over his imaginary misfortune. If moreover possessed of power, and endowed with a perverse disposition and a sanguinary heart, and image is rendered still more repulsive.”

Because the disturbed feelings are generally a striking feature of depression, it has become customary in recent years to regard this condition as a “primary mood disorder” or as an “affective disorder.” The central importance ascribed to the feeling component of depression is exemplified by the practice of utilizing affective adjective check lists to define and measure depression. The representation of depression as an affective disorder is a misleading as it would be to designate scarlet fever as a “disorder of the skin” or as a “primary febrile disorder.” There are many components to depression other than mood deviation.

Depression may now be defined in terms of the following attributes:

• A specific alteration in mood: sadness, loneliness, apathy
• A negative self concept associated with self-reproaches and self blame.
• Regressive and self punitive wishes: desires to escape, hide or die.
• Vegetative changes: anorexia, insomnia, loss of libido
• Change in activity level: retardation or agitation.
  

Description of Depression