The word melancholy conjures up a sad state of being that is bleak and cheerless. That state of being is also a common feature of major depressive disorder (MDD), so it may seem redundant to attach the word melancholia with depression, as in melancholic depression. While at first glance the term may appear to be repetitive, it is, in fact, an actual subtype of MDD—in essence, a more profound manifestation of major depression.
When someone with MDD presents with the features of melancholia this delineates the disorder in terms of symptoms, which can help the mental health provider zero in on effective treatment solutions. Depression with melancholia, while a challenging diagnosis, is treatable.
About Depression With Melancholia
Major Depression is diagnosed when five or more of nine criteria are met if the symptoms have persisted for more than two weeks. Those nine criteria include:
- Feelings of hopelessness, sorrow, despair
- Insomnia or hypersomnia
- Trouble concentrating
- No interest in the things once enjoyed
- Change in eating habits
- Feelings of shame or guilt
- Thoughts of death or suicide
Melancholic depression has additional features on top of the basic symptoms of major depression. Those who experience severe MDD with added psychotic features are more prone to melancholic depression. There must be three or more of the specific signs of melancholic depression to render it as a subtype of MDD:
- The symptoms of MDD (above) that are worse in the morning hours
- Significant weight loss
- Absence of emotion, even in response to something positive
- Complete loss of pleasure
- Deep sense of despair and worthlessness
- Sleep disturbance, excessive sleep, or inability to get out of bed (anergia)
- Excessive and persistent feelings of guilt
Diagnosing Depression With Melancholia
During the psychological evaluation the doctor will attempt to ascertain the severity of the depression through the use of various assessment tools. During this process the patient will be asked specific questions that will help the doctor determine the patient has the melancholic features. Some of these questions might include:
- Are there any changes in sleep patterns? Describe sleep quality
- Has your daily routine changed recently?
- What things help improve your mood?
- Do you have a more difficult time concentrating?
- Are your symptoms worse in the morning?
- Describe a typical day
- Do you struggle to get out of bed in the morning and proceed with the day?
- Do you enjoy the activities you once did?
The likelihood of patients with MDD also having the melancholic features is higher in those with a family history of bipolar disorder, depression, or suicide.
Treatment Options for Melancholic Depression
Melancholic depression appears to have a genetic or biological origin or cause, versus being triggered by a life event. As with MDD, treatment for depression with melancholia involves a combination of both antidepressant therapy and psychotherapy. The SSRIs, or other types of antidepressants, are designed to help normalize brain chemistry, specifically to improve the functioning of neurotransmitters, such as serotonin or norepinephrine.
Psychotherapy is helpful to give the patient tools and suggestions for managing the symptoms of melancholic depression, such as not being able to get out of bed in the morning, regaining a sense of control in life, or helping them process the feelings of guilt and despair they struggle with. Group therapy can also be helpful, providing a sense of not being alone with the struggles of this disorder.
TMS Therapy for Treatment-Resistant Depression With Melancholia
Unfortunately, a large percentage of patients do not respond to the antidepressant therapy, even after trialing several of them. These patients are deemed to be treatment-resistant, which can be very frustrating for them. Transcranial magnetic stimulation (TMS) offers hope for patients who did not find relief through medication.
TMS is a noninvasive, safe, and highly effective alternative therapy for depression and melancholic depression. This brain stimulation technique uses magnetic pulses to create electrical currents. The electrical currents penetrate the targeted region up to two centimeters into the brain tissue, stimulating the neurons that were sluggish. Over a period of 4-6 weeks, TMS therapy has the ability to normalize brain chemistry, which results in symptom relief.
TMS therapy is very well tolerated with few side effects reported. The therapy does not require any type of anesthesia, so it is safer than other brain stimulation techniques that require a general anesthesia. Patients are fully alert during the treatments and can immediately return to normal daily activities.
Anew Era TMS Provides Effective TMS Therapy for Melancholic Depression
Anew Era TMS is a leading provider of TMS therapy in Orange County, California. As specialists who treat individuals struggling with depression with melancholia, the doctors and TMS technicians at Anew Era TMS are considered industry experts in the field. TMS therapy has changed the lives of hundreds of patients at Anew Era TMS. Call us today at (888) 503-1549 to see how TMS therapy can change your life.