The 5 Most Important Differences Between Depression And Melancholy
Depression is the largest 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. Exactly what 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?.
The relationship between depression and melancholy
Before seeing the differences between depression and melancholy, we must briefly introduce the two. Depression does not need a great cover letter, since this disorder is quite common and well-known. In fact, it is so common that it is credited with being the largest cause of disability worldwide. Clinical depression is a mood disorder in which feelings such as sadness, loss, anger and frustration appear that intervene in daily life for several weeks, months or years.
Defining melancholy is a problem in itself, since its scientific definition has been varying since it was conceptualized. and, in fact, it has gone from mental disorder to state within another mental disorder depending on the period of history and the psychological and psychiatric paradigm from which it is observed. Nowadays, melancholy, within clinical psychology and psychiatry, is considered a subtype of depression, a distinction being made between non-melancholic depressions and melancholic depressions.
People with melancholic depression often feel extremely hopeless and guilty. , having serious difficulties feeling the slightest bit of happiness, even for those things that are objectively pleasant. It is considered that melancholy (or melancholic depression) is one of the most difficult to treat, although not impossible as long as you have the appropriate tools for it.
The origin of the word “melancholy” and its relationship with depression can be found in Classical Antiquity. Around 400 BC the Greek philosopher Hippocrates theorized that the human body contained four main fluids: blood, black bile, yellow bile, and phlegm; whose balance, if altered, caused illness. An excess of black bile (“melas kholi”) made the person sad, depressed and afraid, a state which was called “melankholia”. This is the first term used for depression and the first record of medical study of it.
The historical journey of this word is very extensive, which has made it become a collection of ideas more or less related to pathological sadness. It has also been related to genius in 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. There was the idea that the sunken and depressed artist was brilliant in his good expressive work.
In the 18th century the term gradually acquired a more purely emotional background. , used to describe those people who were either depressed or had a low mood. Already entering the 19th century, depression and melancholy were two terms used practically synonymously. Sigmund Freud would be the one who would modernize this concept a little later, giving it the 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. Melancholy is considered a state within mood disorders. with which a diagnosis of melancholy is not given, but rather the diagnosis of the disorder with it, such as major depressive disorder with melancholic features or bipolar disorder with a depressive phase with melancholy.
But despite not being an independent mental disorder, it does have diagnostic criteria. For a person to be diagnosed with melancholic depression, they must present at least one of the following two symptoms:
And at least three of the following symptoms.
The differences between depression and melancholy, explained
Although it is not a mental disorder in itself, as categorized in the DSM, there are several differences that we can find with respect to non-melancholic depressions. The symptoms are usually more serious, for example, while in non-melancholic depression there is usually fatigue and a low mood at pathological levels, in melancholic depression 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, what causes this imbalance does not have to be of 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 trauma. On the other hand, melancholic disorders are attributed to an endogenous cause and are directly related to genetics and biology. In fact, melancholic depressions have a high hereditary component it is common for those who are diagnosed to have a family history of depression, bipolar disorder and suicide.
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 depressive symptoms. Social and psychological factors can influence the appearance of melancholic depression, but not as much as in non-melancholic depression.
The brain structure of people who suffer from melancholy has also been addressed. Research suggests that these types of patients usually have fewer neurons connecting their insula , a region of the brain responsible for attention. In addition, these types of patients also have other brain regions altered, including the hypothalamus, the pituitary gland and the 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 system have been associated with inhibition of appetite 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 depression have higher REM phases, while their deep sleep phases are shorter. This translates into poorer sleep quality. Their sleep-wake cycle is altered, and this is seen in the fact that people with melancholy usually get up earlier in the morning. Problems and changes in sleeping habits are common in all depressions, but a distinctive feature of melancholic depression is waking up earlier, while in non-melancholic depression people can sleep more or less, and wake up at different times.
4. Cognitive problems
Some studies suggest that within depression, although it is already common to find alterations in cognitive abilities, they would be especially present in melancholic type. Problems in working memory, concentration, attention, visual learning, verbal learning and problem solving and these would be specific symptoms of melancholic type depression.
5. Placebo response
Melancholy does not seem to respond to placebo, while major depression has a placebo response that exceeds 40%. Melancholy shows a great response to pharmacological treatments, especially to antidepressants that work on a large number of neurotransmitters rather than just one. It also seems to have good results with electroconvulsive therapy.
