Is melancholia the only true type of depression?

According to an article in Psychology Today melancholic depression is the only true type of depression. The author claims that what800px-Melancholicdepression passes for major depression today is equivalent to what people used to commonly refer to as “nerves” since many people who are depressed today don’t necessarily feel sad. “Depressed” individuals today often demoralized, feel extremely fatigued, anxious, and have numerous physical complaints which can be treated with SSRIs while true depressives respond more to tricyclics and ECT.

There is a major problem with the diagnosis of “depression,” and this is that it doesn’t exist. There is such a thing as “melancholia,” a very serious from of depression entailing risk of suicide and complete lack of pleasure in life. But, hey! for years this illness was called by its proper name, melancholia, and there is no reason why we can’t continue to do so. Melancholia is, in fact, in the Diagnostic and Statistical Manual of the American Psychiatric Association, the famous “DSM,” but as a subtype of major depression.

I agree that depression is vaguely defined and heterogeneous in comparison to other illnesses but melancholic depression is not the only type of depression. While sadness is often associated with melancholic depression one doesn’t have to feel necessarily sad in order to qualify for the label. In fact I have heard many describe typical depression’s mood as a lack of feeling when very severe. In my experience one’s depression can change over the course of time as well. For example, when younger, I felt much greater sadness when a teenager than as an adult.

A second issue is one regarding symptoms. The symptoms that he lists as “nerves” are more commonly associated with atypical depression which are in turn is associated more often with bipolar depression , a type of depression with a significant genetic component. Other types of depression which are also often more atypical in nature are SAD and dysthymia.  While SAD is not as severe as melancholic depression, it has a close relationship with bipolar disorder and according to some studies it has unigue biological characteristics. Instead of an overactive HPA axis some have found an underactive HPA axis. According to research atypical depression while less severe seems just as legitimate as typical/melancholic depression.

When I researched various types of depression in the past it became apparent that the typical/atypical distinction while somewhat useful is oversimplified and features such as diurnal variation could change over the course of the episode. Additionally people often have a combination of both types of depression. Bipolar depression for example, often manifests itself as melancholic and atypical.  Melancholia imparts symptoms such as sadness, guilt and a motor impairments. The atypical  aspect can cause over sleeping, weight gain and extreme fatigue. In the end depression, while vague defined, has many faces that the author doesn’t see or acknowledge.

 

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