Overview
Melancholic depression is a subtype of major depressive disorder characterized by profound sadness, loss of pleasure in almost all activities, and physical symptoms such as slowed movements or weight loss. In Korea, melancholic depression is recognized as a biologically influenced form of depression, requiring structured medical and psychological treatment in psychiatric hospitals and community mental health centers.
What is Depression (Melancholic)?
Melancholic depression is marked by severe, biologically driven depressive symptoms, which are less influenced by external events. Patients often experience:
- Anhedonia (loss of pleasure in all activities)
- Early morning awakening
- Significant weight loss
- Excessive guilt
- Psychomotor changes (slowed or agitated movements)
It is considered a serious condition and often requires a combination of medication and therapy for effective treatment.
Symptoms
- Persistent sadness or emptiness
- Loss of interest or pleasure in nearly all activities
- Early morning awakening and inability to return to sleep
- Significant weight loss or decreased appetite
- Excessive guilt or feelings of worthlessness
- Psychomotor retardation or agitation
- Fatigue or low energy
- Impaired concentration or indecisiveness
Causes
- Genetic predisposition (family history of depression)
- Neurochemical imbalances (serotonin, norepinephrine, dopamine)
- Hormonal dysregulation (HPA axis dysfunction)
- Brain structural changes affecting mood regulation
- Stressful life events may trigger episodes, but biological factors dominate
Risk Factors
- Previous episodes of major depression
- Family history of melancholic depression
- Chronic medical illnesses (e.g., diabetes, cardiovascular disease)
- Significant life stressors or trauma
- Age (commonly adults 25–50 years)
- Female gender (higher prevalence)
Complications
- Increased risk of suicide or self-harm
- Chronic functional impairment in social, academic, or work life
- Co-occurring psychiatric disorders (anxiety, substance abuse)
- Physical complications from weight loss or neglect of health
- Recurrence of depressive episodes if untreated
Prevention
- Early identification and treatment of symptoms
- Regular mental health screening for at-risk populations
- Healthy lifestyle: diet, sleep, exercise
- Stress management via mindfulness or relaxation techniques
- Support networks of family, friends, or community
Treatment Options in Korea
- Diagnosis
- Psychiatric evaluation using DSM-5 criteria
- Structured interviews and rating scales (HAM-D, PHQ-9)
- Lab tests to rule out metabolic or hormonal causes
- Medical Treatments
- Antidepressants: SSRIs, SNRIs, tricyclic antidepressants
- Augmentation therapy: lithium or atypical antipsychotics for resistant cases
- Electroconvulsive Therapy (ECT): effective for severe or treatment-resistant melancholic depression
- Psychological Therapies
- Cognitive Behavioral Therapy (CBT)
- Interpersonal Therapy (IPT)
- Psychodynamic therapy for underlying emotional conflicts
- Rehabilitation & Support
- Hospitalization in severe cases for intensive monitoring and therapy
- Community-based outpatient care
- Peer support groups and psychoeducation for patients and families
