Depression is the leading cause of disability around the world. This is not to be a little sad, but it is a serious health problem, mental disorder, clinical condition, and just as it is clear that cancer or a bone fracture requires intervention, it is is the same for depression.
There is another word closely related to depression: melancholy. Some use the two words indiscriminately, others put them together like a matryoshka on the wrist. What exactly are they? Are there any differences between the two?
Defining the relationship between depression and melancholy is a bit complicated, but not impossible. Below we will see what are the differences between depression and melancholy and how they relate.
The relationship between depression and melancholy
Before we look at the differences between depression and melancholy, we need to give a brief introduction to both. Depression doesn’t need a big cover letter because this disorder is quite common and well known. In fact, it is so common that it is considered the leading cause of disability around the world. Clinical depression is a mood disorder in which feelings such as sadness, loss, anger, and frustration arise that occur in everyday life for several weeks, months, or years.
Defining melancholy is itself a problem, as its scientific definition has varied since its conceptualization. and, in fact, it has gone from being a mental disorder to that of another mental disorder depending on the period of history and the psychological and psychiatric paradigm from which it is observed. Today, melancholy, in clinical psychology and psychiatry, is considered a subtype of depression, distinguishing between non-melancholic and melancholic depressions.
People with melancholy depression often feel extremely hopeless and guiltyHave serious difficulty feeling the slightest pinch of happiness, even for things that are objectively pleasant. Melancholy (or melancholy depression) is considered one of the most difficult to deal with, but not impossible as long as you have the right tools for it.
History of melancholy
The origin of the word “melancholy” and its relation to depression can be found in classical antiquity. Around 400 BC, the Greek philosopher Hippocrates hypothesized that the human body contained 4 main fluids: blood, black bile, yellow bile and phlegm; the balance, if altered, caused disease. Too much black bile (“melas kholi”) made the person sad, depressed and frightened, a condition called “melankholia”. It is the first term used to refer to depression and the first recording of its medical study.
The historical trajectory of this word is very extensive, which has made it a collection of ideas more or less linked to pathological sadness. It has also been associated with genius at certain times in history, such as the Renaissance and Romanticism., Considering the “melancholy” artist as a tormented mind, suffering is the cause of his genius. The idea was that the engulfed and depressed artist was good at his good expressive creation.
In the 18th century, the term gradually acquired a more purely psychic background., Used to describe people who are depressed or in a bad mood. As early as the 19th century, depression and melancholy were two terms used almost as synonyms. Sigmund Freud would be the one who would later modernize this concept, giving it the current definition in his essay “Mourning and Melancholy”.
Is melancholy a disorder?
One of the main differences between depression and melancholy is that, as DSM is currently organized, the former is an independent disorder while the latter is not. Melancholy is considered a state of mood disorders, With which a diagnosis of melancholy is not given, but that of the disorder with it because it may be a disorder of greater depression with melancholic features or bipolar disorder with depressive phase with melancholy .
But although it is not an independent mental disorder, it does have diagnostic criteria. For a person diagnosed with melancholic depression to have at least one of the following two symptoms:
- Loss of pleasure with almost any activity.
- Weak or no response to objectively satisfactory events
And at least three of the following symptoms.
- Despair is not associated with loss or pain
- Loss of appetite or significant weight loss.
- Psychomotor changes: both physical agitation and slower movements.
- Get up two hours earlier than usual.
- Excessive guilt.
The differences between depression and melancholy, explained
While this is not a mental disorder per se, as categorized in the DSM, there are several differences we can find regarding non-melancholic depression.. Symptoms are usually more severe, for example, while in non-melancholic depression there is usually fatigue and depressed mood at pathological levels in melancholy, the person does not feel any capacity to experience pleasure with tasks pleasant, in addition to not being completely energetic.
1. Endogen Vs. exogenous
But of all the differences that can be found between depression and melancholy, this is what causes it. While most of the scientific community agrees that whatever it is depression must be related to some kind of altered levels of neurotransmitters in the brain, what is causing this mismatch must not be internal in origin.
Non-melancholic depressions are considered to be of the exogenous type, caused by a problem external to the person such as the death of a loved one, being the victim of abuse or suffering a trauma. In contrast, melancholy is attributed to an endogenous cause directly related to genetics and biology. In fact, melancholic depressions have a high hereditary componentIt is common for people diagnosed to have a family history of depression, bipolar disorder, and suicide.
But despite being of endogenous origin, this does not mean that melancholic depression is not made worse by environmental factors. This type of depression can manifest on a seasonal pattern, making its symptoms more common in the winter when there is less sun and colder weather, factors that increase depressive symptoms. Social and psychological factors can influence the onset of melancholic depression, but not as much as non-melancholic ones.
2. Structure of the brain
The brain structure of people with melancholy was also discussed. Research suggests that these patients tend to have fewer neurons connecting their insula, A region of the brain responsible for attention. In addition, this type of patient also altered other areas of the brain, including the hypothalamus, pituitary and adrenal glands (hypothalamic-pituitary-adrenal axis).
Another of the biological characteristics of melancholic people is that they have higher cortisol levels. These changes and alterations in the nervous and endocrine systems have been associated with suppressed appetite and increased stress levels in melancholy. In turn, this change in this hormone would cause greater weight loss and there is also chronic inflammation.
3. Sleep-wake cycle
People with melancholic-type depression have higher REM phases, while deep sleep phases are shorter.. This results in poorer quality of sleep. Their sleep-wake cycle is altered, and this can be seen in the fact that melancholic people usually get up early in the morning. Having problems and changes in sleep patterns is common in all depressions, but waking up earlier is a hallmark of melancholy, while in a non-melancholy state you may both sleep less and less and wake up on different times.
4. Cognitive problems
Some studies point out that in depressions, although it is already common to find alterations in cognitive abilities, they are mainly present in those of the melancholic type. Memory problems Work, concentration, attention, visual, learning verbal learning and problem solving and would be these specific symptoms of melancholic type depressions.
5. Response to Placebo
Melancholy does not appear to respond to placebo, while major depression has a placebo response greater than 40%. Melancholy shows a great response to pharmacological treatments, in particular to antidepressants which act on a large number of neurotransmitters rather than just one. He also seems to have good results against electroconvulsive therapy.
- Parker, G., McCraw, S., Blanch, B., Hadzi-Pavlovic, D., Synnott, H. and Rees, AM (2013). Discrimination of mixolic and non-mixolic depression by prototypical clinical features. Journal of Affective Disorders, 144 (3), 199-207. https://doi.org/10.1016/j.jad.2012.06.042
- Foti, D. et al (2014). Reward Dysfunction in Major Depression: Multimodal Neuroimaging Tests to Refine the Melancholic Phenotype. NeuroImage, 101, pages 50-58.
- Milena, Laura and Segovia Nieto, Laura Milena. (2014). The melancholic experience: a differential configuration between major depression and melancholy. Hispano-American psychology notebooks. 14. 10.18270 / chps..v14i2.1334