Depression with melancholic features is a diagnostic specifier for depression. The hallmark features are a complete loss of pleasure, low reactivity, and slowed movements.
Depression is an umbrella term for major depressive disorder (MDD), also called major depression or clinical depression. There are different subtypes of depression, many of which are characterized by intense feelings of hopelessness and loss of interest.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) includes depression specifiers that make a depression diagnosis more specific.
Depression with melancholic features — also known as melancholic depression or melancholia — is a depression specifier characterized by a total lack of pleasure.
The hallmark symptoms of melancholic depression are a loss of pleasure and interest in all (or almost all) activities you used to enjoy, and not feeling much better — if at all — when something good happens (a lack of reactivity).
To receive a diagnosis of melancholic depression you will also have three or more of the following symptoms:
- a mood defined by “profound despondency, despair, and/or moroseness,” or feeling empty
- worse depression in the morning
- waking up early, such as 2 hours earlier than usual
- intense restlessness (psychomotor agitation) or visibly slowed movements
- significant weight loss
- excessive feelings of guilt
Loss of pleasure is also a feature of major depression, but the DSM-5 states that melancholic depression involves a “near-complete absence of the capacity for pleasure, not merely a diminution.”
To be diagnosed with melancholic depression you must first have a diagnosis of major depression. The symptoms of major depression include having most of the following symptoms for 2 or more weeks:
- persistent feelings of loneliness or sadness
- lack of energy or fatigue
- feelings of hopelessness
- sleep disturbances
- change in appetite
- difficulties with concentration or focus
- loss of interest in enjoyable activities
- feelings of guilt and worthlessness
- thoughts of death or suicide
These symptoms can make it difficult to get through the day. They affect all areas of functioning, including school, work, and social life.
People often talk about depression as though it were one condition, but it’s more complex than that.
Melancholic depression is one of several types of depression. Most types share the core symptoms of depression, such as sadness, hopelessness, fatigue, and trouble sleeping.
Depression specifiers distinguish different ways depression can present, such as the specific symptoms and their severity.
The two main distinguishing symptoms of melancholic depression are a severe loss of interest in activities and difficulty reacting to positive stimuli. Loss of interest and pleasure are symptoms of MDD and other subtypes of depression, but it’s more severe in melancholic depression.
Compared with other forms of depression, people with melancholic depression may be more likely to have physical symptoms. They often have slowed movements or speech that’s observable by others. They may find it difficult to get enough sleep due to waking up early and may be more likely to have significant weight loss.
Diagnostic specifiers help mental health professionals make treatment more specific to your symptoms.
The DSM-5 lists the following specifiers for major depressive disorder:
- anxious distress
- mixed features
- melancholic features
- atypical features
- psychotic features
- peripartum onset, also known as postpartum depression
- seasonal pattern, also known as seasonal affective disorder
Like other types of depression, you can manage melancholic depression with the right treatment. This may involve medication, talk therapy, or a combination of both, as determined by your mental health care professional.
Antidepressants are the typical medication prescribed for melancholic depression. Your psychiatrist may prescribe:
- selective serotonin reuptake inhibitors (SSRIs)
- serotonin-norepinephrine reuptake inhibitors
- tricyclic antidepressants
- monoamine oxidase inhibitors (MAOIs)
Talk therapy, also known as psychotherapy, involves meeting with a therapist or psychotherapist to discuss your symptoms and how they affect your life.
Cognitive behavioral therapy (CBT) is the most common form of talk therapy.
According to the American Psychological Association (APA), CBT involves strategies and efforts to relieve symptoms by changing your thinking patterns.
The clinical name for “melancholic depression” is MDD with melancholic features. Getting a diagnosis of depression involves speaking with a doctor or therapist.
A doctor may perform some tests to rule out other medical conditions that could be the underlying cause of your symptoms. They may ask about your symptoms to rule out other mental health conditions.
Melancholic depression can make it very difficult to function in your everyday life. It can interfere with your balance between work, school, and personal life, and you may have trouble fulfilling your duties.
If you suspect you may have melancholia, talking with a doctor is a good first step. A primary care doctor or psychiatrist can listen to your symptoms and prescribe medication like antidepressants, which are effective treatment options for depression.
Seeing a therapist and participating in talk therapy can also be an effective way to manage your symptoms. A therapist can help you change your thinking and, in some cases, your behaviors.
If you aren’t ready to speak to a doctor or therapist, talking with a trusted friend or family member can help you feel less alone. There are also online support groups for people with depression full of listening ears and helpful resources.
Other natural methods that may help you manage symptoms of depression include:
- prioritizing sleep by practicing healthy sleep practices
- getting a range of nutrients from your food
- exercising regularly, as this releases “feel-good” chemicals like endorphins
- practicing mindfulness or meditation
- looking after yourself with self-care for depression
- spending some time in nature
If you’re living with a subtype of depression, you’re not alone. An estimated 280 million people worldwide have depression, according to the
To get clarity on your symptoms, consider speaking with a doctor or therapist. It can be difficult to take the first step toward getting a diagnosis or discussing treatment options, but this will help you eventually start feeling better.
Depression is a highly treatable condition. Even taking baby steps will help you notice a difference in the severity of your symptoms and how you can manage them.