The 5 most important differences between depression and melancholy

Depression is the leading cause of disability worldwide. It is not about being a little sad, but it is a serious health problem, a mental disorder, a clinical condition and, Just as we are clear that cancer or having a broken bone require intervention, it is 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. We'll see now what are the differences between depression and melancholy and how are they related.

• Related article: "Major Depression: Symptoms, Causes, and Treatment"

The relationship between depression and melancholy

Before seeing the differences between depression and melancholy, we must make a brief introduction of the two. Depression does not need a large cover letter, since this disorder is quite common and well known. In fact, it is so common that it is credited with being the world's leading cause of disability. Clinical depression is a mood disorder in which feelings such as sadness, loss, anger, and frustration appear and intervene in daily life for several weeks, months, or years.

Defining melancholy is in itself a problem, since its scientific definition has varied since it was conceptualized and, in fact, it has progressed from a mental disorder to a state within another mental disorder depending on the period of history and the psychological and psychiatric paradigm from which it is observed. Today melancholy, within clinical psychology and psychiatry, is considered a subtype of depression, distinguishing between non-melancholic depressions and depressions melancholic.

People with melancholic depression often feel extremely hopeless and guilty, having serious difficulties to feel the slightest bit of happiness, even for those things that are objectively pleasant. Melancholy (or melancholic depressions) is considered to be one of 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 relationship with depression is found in Classical Antiquity. About 400 a. C. greek philosopher Hippocrates he theorized that the human body contained four main fluids: blood, black bile, yellow bile, and phlegm; whose balance, if disturbed, caused disease. An excess of black bile ("melas kholi") made the person sad, dejected and afraid, a state which was called "melankholia". This is the first term used for depression and the first record of its medical study.

The historical journey of this word is very extensive, which has made it a collection of ideas more or less related to pathological sadness. It has also been related to genius at some moments in history, such as the Renaissance and Romanticism., considering the "melancholic" artist as a tormented mind whose suffering is the cause of his genius. You had the idea that the sunken and depressed artist was great at his expressive good work.

In the 18th century the term gradually acquired a more purely psychic background, used to describe those people who were either depressed or in low mood. Well into the nineteenth century depression and melancholy were two terms used practically synonymously. Sigmund Freud would be the one who a little later would modernize this concept, giving it the current definition in his essay "Duel and melancholy."

Is melancholy a disorder?

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

But despite not being an independent mental disorder, it does have diagnostic criteria. For a person to be diagnosed with melancholic depression, they 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 loss or pain
• Loss of appetite or significant weight loss.
• Psychomotor changes: both physical restlessness and slower movements.
• Get up two hours earlier than normal.
• Excessive guilt.

The differences between depression and melancholy, explained

Although it is not a mental disorder in itself, as it is categorized in the DSM, there are several differences that we can find with respect to non-melancholic depressions. Symptoms tend to be more severe, for example, while in non-melancholic depression there is often fatigue and low mood at low levels. pathological in melancholic the person does not feel any capacity to feel pleasure with pleasant tasks, in addition to completely lacking energies.

1. Endogenous vs. exogenous

But of all the differences that can be found between depression and melancholy, there is what causes it. Although most of the scientific community agrees that depression, whatever it may be, has to be related to some type of alteration in the levels of neurotransmitters in the brain, which causes this imbalance does not have to be of origin internal.

Non-melancholic depressions are considered to be exogenous, caused by some 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 ones are attributed an endogenous cause and directly related to genetics and biology. In fact, melancholic depressions have a high hereditary component, being common in those who are diagnosed to have a family history of depression, bipolar disorder and suicides.

But despite being of endogenous origin, it 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 symptoms depressive Social and psychological factors can influence the onset of melancholic depression, but not as much as non-melancholic ones.

2. Brain structure

The brain structure of people with melancholy has also been addressed. Research indicates that these types of patients tend to have fewer neurons connecting their insula, a region of the brain responsible for attention. In addition, these types of patients also have altered other brain regions, including the hypothalamus, the pituitary gland and the 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 appetite suppression and higher levels of stress in melancholy. In turn, this alteration in this hormone would be behind the experience of a greater weight loss and there is also chronic inflammation.

• You may be interested in: "Parts of the human brain (and functions)"

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 disrupted, and this is seen in the fact that people with melancholy tend to get up earlier in the morning. That there are problems and changes in sleep habits is common in all depressions, but it is a distinctive feature of the melancholic ones to wake up earlier, while in non-melancholic ones it is possible both to sleep more and less, and to wake up in different schedules.

4. Cognitive problems

Some studies suggest that within depressions, although it is already common to find alterations in cognitive abilities, they would be especially present in those of the melancholic type. Problems in working memory, concentration, attention, visual learning, verbal learning and problem solving and these would be 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 that exceeds 40%. Melancholy shows a great response to pharmacological treatments, especially antidepressants that work on a large number of neurotransmitters rather than just one. It also seems to have good results with electroconvulsive therapy.

Bibliographic 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). The melancholic experience: a differential configuration between major depression and melancholy. Hispano-American Notebooks of Psychology. 14. 10.18270 / chps..v14i2.1334