- Last edited on August 9, 2023
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mood:1-depression:melancholic [on August 9, 2023] psychdb |
mood:1-depression:melancholic [on August 9, 2023] psychdb [Primer] |
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* Melancholic depression is considered to be a more "biologically-based" depression. | * Melancholic depression is considered to be a more "biologically-based" depression. | ||
* Individuals often have hypercortisolemia and there is a strong genetic and familial association in melancholic depression. Theories on the pathophysiology of melancholic depression include disruption of the HPA axis.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149795/|Levitan, R. D., Vaccarino, F. J., Brown, G. M., & Kennedy, S. H. (2002). Low-dose dexamethasone challenge in women with atypical major depression: pilot study. Journal of Psychiatry and Neuroscience, 27(1), 47.]])][([[http://www.psychiatrictimes.com/electroconvulsive-therapy/endocrine-psychiatry-dexamethasone-suppression-test-and-electroconvulsive-therapy|Kellner, C. H. (2011). Endocrine psychiatry: the dexamethasone suppression test and electroconvulsive therapy. Psychiatric Times, 28(3), 57-57.]])] | * Individuals often have hypercortisolemia and there is a strong genetic and familial association in melancholic depression. Theories on the pathophysiology of melancholic depression include disruption of the HPA axis.[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC149795/|Levitan, R. D., Vaccarino, F. J., Brown, G. M., & Kennedy, S. H. (2002). Low-dose dexamethasone challenge in women with atypical major depression: pilot study. Journal of Psychiatry and Neuroscience, 27(1), 47.]])][([[http://www.psychiatrictimes.com/electroconvulsive-therapy/endocrine-psychiatry-dexamethasone-suppression-test-and-electroconvulsive-therapy|Kellner, C. H. (2011). Endocrine psychiatry: the dexamethasone suppression test and electroconvulsive therapy. Psychiatric Times, 28(3), 57-57.]])] | ||
- | * There is concern from some clinicians that the proper diagnosis and treatment of melancholic depression has been overshadowed by the introduction of mass-marketed SSRIs.[([[http://www.nejm.org/doi/full/10.1056/NEJMbkrev57417|Taylor, M. A., & Fink, M. (2006). Melancholia: the diagnosis, pathophysiology and treatment of depressive illness. Cambridge University Press.]])] There is evidence to suggest that melancholic depression responds better to TCAs and ECT.[([[http://www.psychiatrictimes.com/cme/update-melancholia/page/0/5|Psychiatric Times: An Update on Melancholia]])][([[https://www.ncbi.nlm.nih.gov/pubmed/8835647|Perry, P. J. (1996). Pharmacotherapy for major depression with melancholic features: relative efficacy of tricyclic versus selective serotonin reuptake inhibitor antidepressants. Journal of affective disorders, 39(1), 1-6.]])] | + | * There is concern from some clinicians that the proper diagnosis and treatment of melancholic depression has been overshadowed by the introduction of mass-marketed SSRIs.[([[http://www.nejm.org/doi/full/10.1056/NEJMbkrev57417|Taylor, M. A., & Fink, M. (2006). Melancholia: the diagnosis, pathophysiology and treatment of depressive illness. Cambridge University Press.]])] |
+ | * There is some evidence to suggest that melancholic depression responds better to TCAs and ECT.[([[http://www.psychiatrictimes.com/cme/update-melancholia/page/0/5|Psychiatric Times: An Update on Melancholia]])][([[https://www.ncbi.nlm.nih.gov/pubmed/8835647|Perry, P. J. (1996). Pharmacotherapy for major depression with melancholic features: relative efficacy of tricyclic versus selective serotonin reuptake inhibitor antidepressants. Journal of affective disorders, 39(1), 1-6.]])] | ||
== Epidemiology == | == Epidemiology == | ||
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== Prognosis == | == Prognosis == | ||
- | * Melancholic depression often progresses into psychotic depression (where delusions are usually nihilistic in nature). | + | * Melancholic depression often progresses into psychotic depression (where [[teaching:delusions-hallucinations|delusions]] are usually nihilistic in nature). |
* Melancholic depression is shorter in duration and more episodic. It also features diurnal variation (early-morning worsening of mood, with an afternoon slump or evening worsening).[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181887/|Wirz-Justice A. Diurnal variation of depressive symptoms. Dialogues in Clinical Neuroscience. 2008;10(3):337-343.]])] | * Melancholic depression is shorter in duration and more episodic. It also features diurnal variation (early-morning worsening of mood, with an afternoon slump or evening worsening).[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181887/|Wirz-Justice A. Diurnal variation of depressive symptoms. Dialogues in Clinical Neuroscience. 2008;10(3):337-343.]])] | ||