The 5 most important differences between depression and melancholy

These are the aspects that help distinguish between depression and melancholy.

Depression is the biggest cause of disability worldwide. It's not just about being a little sad, it's a serious health problem, a mental disorder, a clinical condition, and just as we are clear that Cancer or having a broken bone requires intervention, it's the same case for depression.

There is another word that is closely related to depression: melancholy. Some use both words interchangeably, others put one inside the other like a matrioshka doll. What exactly are they? Are there differences between the two?

Defining the relationship between depression and melancholy is somewhat complicated, but not impossible. In the following we will see what are the differences between depression and melancholy and how are they related?.

The relationship between depression and melancholy.

Before looking at the differences between depression and melancholy, we must make a brief introduction of the two. Depression does not need a big letter of introduction, since this disorder is quite common and well known. In fact, it is so common that it is attributed to be the major cause of disability worldwide. Clinical depression is a mood disorder in which feelings such as sadness, loss, anger and frustration interfere with daily life for several weeks, months or years.

Defining melancholy is in itself a problem, since its scientific definition has been varying since it was first conceptualized. and, in fact, it has gone from a mental disorder to a state within another mental disorder according to the period of history and the psychological and psychiatric paradigm from which it is observed. Today melancholia, within clinical psychology and psychiatry, is considered a subtype of depression, with a distinction being made between non-melancholic depressions and melancholic depressions.

People with melancholic depression tend to feel extremely hopeless and guilty, having serious difficulties to feel the best of their lives.having serious difficulties to feel the slightest hint of happiness, even for those things that are objectively pleasant. Melancholy (or melancholic depressions) are considered to be among the most difficult to treat, although not impossible as long as you have the right tools to do so.

History of melancholy

The origin of the word "melancholy" and its relation to depression can be found in Classical Antiquity. Around 400 B.C., the Greek philosopher Hippocrates theorized that the human body contained four main fluids: blood, black bile, yellow bile and phlegm, the balance of which, if disturbed, caused disease. An excess of black bile ("melas kholi") made the person sad, depressed and fearful, a state which was called "melankholia". This is the first term used for depression and the first record of its medical study.

The historical trajectory of this word is very extensive, which has caused it to become a collection of ideas more or less related to pathological sadness. It has also been related to genius in some moments of history, as in the case of the Renaissance and Romanticism, considering the artist as "melancholic".considering the "melancholic" artist as a tormented mind whose suffering is the cause of his genius. It was thought that the sunken and depressed artist was great in his expressive skills.

In the eighteenth century the term gradually acquired a more purely emotional background, used to describe those who were either depressed or in a low mood.It was used to describe those people who were either depressed or in a low state of mind. By the 19th century depression and melancholy were two terms used practically as synonyms. Sigmund Freud would later modernize this concept, giving it its current definition in his essay "Mourning and melancholy".

Is melancholy a disorder?

One of the main differences between depression and melancholia is, as the DSM is currently organized, the former is an independent disorder while the latter is not. Melancholia is considered to be a state within the mood disorders.Therefore, a diagnosis of melancholy is not given, but the diagnosis of the disorder with it, such as major depressive disorder with melancholic features or bipolar disorder with depressive phase with melancholy.

But in spite of not being an independent mental disorder it does have diagnostic criteria. For a person to be diagnosed with melancholic depression, he or she must have at least one of the following two symptoms:

• Loss of enjoyment with virtually any activity.
• Low or no positive response to objectively pleasant events.

And at least three of the following symptoms.

• Despair is not associated with a loss or pain.
• Significant loss of appetite or weight loss.
• Psychomotor changes: both physical restlessness and slower movements.
• Getting up two hours earlier than usual.
• Excessive guilt.

Differences between depression and melancholy, explained

Aunque no es un trastorno mental en sí, tal y como está categorizado en el DSM, sí que son varias las diferencias que podemos encontrar con respecto a las depresiones no melancólicas. Los síntomas suelen ser más graves, por ejemplo, mientras que en la depresión no melancólica suele haber fatiga y estado de ánimo bajo a niveles patológicos en las melancólicas la persona no siente capacidad alguna para sentir placer con tareas agradables, además de carecer por completo de energías.

1. Endógeno vs. exógeno

Pero de todas las diferencias que se pueden encontrar entre la depresión y la melancolía está lo que la causa. Si bien la mayor parte de la comunidad científica coincide en pensar que la depresión, sea cual sea, tiene que tener relación con algún tipo de alteración en los niveles de neurotransmisores en el cerebro, lo que provoca ese desajuste no tiene por qué ser de origen interno.

Non-melancholic depressions are considered to be of an exogenous type, caused by a problem external to the person, such as the death of a family member, being a victim of abuse or experiencing a trauma. On the other hand, melancholic depressions are attributed an endogenous cause and are directly related to genetics and biology. In fact, melancholic depressions have an endogenous cause, melancholic depressions have a high hereditary component, being common in those diagnosed with melancholic depression.It is common for those diagnosed to have a family history of depression, bipolar disorder and suicides.

But despite being of endogenous origin, this does not mean that melancholic depression is not worsened by environmental factors. This type of depression can manifest itself following a seasonal pattern, making its symptoms more common in winter when there is less sunlight and it is colder, factors that increase the depressive symptomatology. Social and psychological factors may influence the onset of melancholic depression, but not as much as in non-melancholic ones.

2. Brain structure

The brain structure of people suffering from melancholy has also been addressed. Research suggests that this type of patient tends to have fewer neurons connecting their insula, a region of the brain responsible for the development of melancholy.a region of the brain responsible for attention. In addition, this type of patient also has alterations in other brain regions, including the hypothalamus, pituitary and adrenal glands (hypothalamic-pituitary-adrenal axis).

Another biological characteristic of melancholic people is that they have higher cortisol levels. These changes and alterations in the nervous and endocrine systems have been associated with appetite inhibition and higher levels of stress in melancholy. In turn, this alteration in this hormone would be behind experiencing greater weight loss and also chronic inflammation.

3. Sleep-wake cycle

People with melancholic-type depressions have higher REM phases, while their deep sleep phases are shorter.. This results in a poorer quality of sleep. Their sleep-wake cycle is altered, and this is seen in the fact that people with melancholy tend to wake up earlier in the morning. Problems and changes in sleep habits are common in all depressions, but it is a distinctive feature of melancholic people to wake up earlier, while non-melancholic people can sleep more or less, and wake up at different times.

4. Cognitive problems

Some studies point out that within depressions, although it is already common to find alterations in cognitive abilities, they would be especially present in the melancholic type. Problems in working memory, concentration, attention, visual learning, verbal learning and problem solving, verbal learning and problem solving would be specific symptoms of melancholic type depressions..

5. Response to placebo

Melancholia does not seem to respond to placebo, whereas major depression has a placebo response of over 40%.. Melancholia shows a great response to pharmacological treatments, especially to antidepressants that work on a wide number of neurotransmitters rather than on a single one. It also seems to have good results to electroconvulsive therapy.

Bibliographical references:

• Parker, G., McCraw, S., Blanch, B., Hadzi-Pavlovic, D., Synnott, H., & Rees, A. M. (2013). Discriminating melancholic and non-melancholic depression by prototypic 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 evidence for refining the melancholic phenotype. NeuroImage, 101, pp. 50 - 58.
• Milena, Laura & Segovia Nieto, Laura Milena. (2014). La experiencia melancólica: una configuración diferencial entre la depresión mayor y la melancolía. Cuadernos Hispanoamericanos de Psicología. 14. 10.18270/chps..v14i2.1334