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Published online by Cambridge University Press: 14 August 2009
But when the melancholy fit shall fall
Sudden from heaven like a weeping cloud,
That fosters the droop-headed flowers all,
And hides the green hill in an April shroud;
Then glut thy sorrow on a morning rose,
Or on the rainbow of salt sand-wave,
Or on the wreath of globed peonies,
Or if thy mistress some rich anger shows
Imprison her soft hand, and let her rave,
And feed deep, deep upon her peerless eyes
We have defined melancholia as a depressive mood disorder characterized by psychomotor retardation and agitation, disturbances in vegetative functions, loss of interest, impaired concentration and memory, delusional thoughts, and preoccupation with suicide. Psychotic depression, depression that is part of a manic-depressive course, depression with catatonia, puerperal depression, and abnormal bereavement are melancholic illnesses. The evidence for including these conditions as melancholic disorders is discussed in Chapter 2.
Many other depressive disorders are delineated in psychiatric classifications that may or may not meet the criteria for melancholia. Atypical depression, dysthymia, seasonal affective disorder (SAD), adjustment disorder with depression, and similar syndromes are poorly defined. They encompass heterogeneous samples of patients who are best considered as having a non-melancholic mood disorder (Table 6.1).
Non-melancholic depressive mood disorders
Non-melancholic “major depression”
Cluster and latent class analyses identify depressed patients who do not exhibit melancholic features (Table 6.2). The studies do not indicate whether this group can be divided further.
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