- About 20 percent of depression patients have the melancholic form
- Melancholic depression responds better to older types of antidepressants
- READ MORE: One in THREE people have had clinical depression
About 10 million Americans with a little-known but serious form of depression are neglected by doctors – because too few people recognize it, experts warn.
Melancholic depression is thought to affect one in five people with the condition, and traditional medication cannot treat it effectively.
The subtype of the disease is characterized by physical symptoms, such as movement problems, complete loss of appetite, unresponsiveness and the inability to perform daily tasks.
Although these may be present in people with regular clinical depression, they are the main element of the melancholic type.
Other more common symptoms include insomnia, low mood and suicidal thoughts.
The areas of the brain affected in melancholic depression are thought to be different from those affected by other forms of depression.
This not only means that symptoms present differently, but also that common treatments such as selective serotonin reuptake inhibitors (SSRIs) are less effective.
Research shows that people with this type are significantly more likely to experience a recurrent episode of illness within the first year of recovery than others.
Now experts are calling for the melancholic illness to be recategorized as its own entity – and not simply as a form of depression – so that patients get the most appropriate treatment.
It comes as the World Health Organization publish updated mental health treatment guidelines (below), which do not describe specific treatment for melancholic depression.
Nearly one in five American adults has depression, and an estimated 15 to 30 percent of those have melancholic symptoms
Dr. Sanil Rege, a leading psychiatrist from Australia, wrote in a series of tweets:
‘We don’t learn enough about melancholic depression!
‘We often tend to think about depression mainly from the emotional side, i.e. gloom and sadness.
‘But the more severe forms of depression, melancholic and psychotic depression, are associated with greater activity and cognitive changes.
‘Treating these depressions as major depression without recognizing the obvious clinical presentation may be associated with failure to respond to antidepressants… and therefore poorer outcomes.’
Melancholic depression tends to present more physical symptoms, such as difficulty moving, concentrating, and a severe lack of sleep
He added that prescribing a regular antidepressant such as sertraline or fluoxetine could actually make the disease worse.
‘Prescribing an antidepressant in such a scenario can worsen anxiety and can also increase the risk of suicide.’
Instead, studies show that older forms of mood enhancers such as tricyclic antidepressants (for example, amitriptyline and doxepin), as well as monoamine oxidase inhibitors (MAOIs) and antipsychotics are more effective.
“Managing” melancholic depression would, he says, address a “large proportion” of cases of treatment-resistant depression: where the drugs don’t work.
A report that appeared last week in the Journal of Affective Disorder found that only a quarter of those with melancholic depression improved when prescribed the popular SSRI citalopram for four months, compared to about half of those without melancholic features who saw improvement.
According to CDC estimates, about one in five American adults have been diagnosed with depression: 51.6 million people. Of these, about 20 percent have the melancholic type, studies estimate.