Melancholia: definition and management
Abstract
Purpose of review To overview historical ascriptions and the current nosological status of melancholia, before reporting diagnostic strategy, biological marker and treatment studies. Recent findings As melancholia has never been satisfactorily differentiated by reliance on symptoms, strategies that adopt a more prototypic approach and incorporate illness correlates in conjunction with symptoms appear to provide greater precision in differentiating melancholic and nonmelancholic depression. An early indicative biological marker – hyperactive Hypothalamic-Pituitary-Adrenal axis functioning – remains supported, whereas a number of other recently proposed candidate markers require clarification. Implications for treatment from recent clinical trials are also discussed. Summary We note that the Diagnostic and Statistical Manual 5 (DSM-5) definition of melancholia [as for Diagnostic and Statistical Manual IV (DSM-IV)] may be limited in its differentiating capacity and so compromise research into melancholia's causes and treatments. Clarifying melancholia's status, primary causes and differential treatment responsiveness awaits more precise definition of this depressive condition.
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A dyshomeostasis-induced sense of low self-efficacy may play a particularly important role in melancholia, a subtype of depression with pronounced somatic symptoms and endocrine disturbances that differs physiologically from other forms of depression with respect to functional connectivity of visceromotor areas, including SGC and ACC.
“Instead, we propose that it may play a particularly important role in melancholia, a subtype of depression with pronounced somatic symptoms and endocrine disturbances (Parker and Paterson, 2014) that differs physiologically from other forms of depression with respect to functional connectivity of visceromotor areas, including SGC and ACC (Guo et al., 2016).”
From Allostatic Self-efficacy: A Metacognitive Theory of Dyshomeostasis-Induced Fatigue and Depression (2016) · cites this paper as Parker and Paterson, 2014
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- Authors
- Parker, G., & Paterson, A.
- Affiliations
- Black Dog Institute (AU)
- Corresponding author
- Parker, Gordon
- ORCID
- Parker, Gordon
- Venue
- Current Opinion in Psychiatry
- Published
- 2014-01
- Volume
- 27
- Issue
- 1
- Pages
- 1-6
- ISSN
- 0951-7367 (ISSN-L)
- OpenAlex
- W4318964140
- Cited by
- 23
- References
- 36
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 3 · 2022: 1 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 3 · 2014: 1 · 2013: 1
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Current Opinion in Psychiatry (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- melancholia, endogenous depression, differential diagnosis of depression, hypothalamic-pituitary-adrenal axis, biomarkers, treatment response, DSM-5 diagnostic criteria
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