The doctrine of the two depressions in historical perspective

Abstract

Objective-To determine if the concept of two separate depressions -melancholia and nonmelancholia -has existed in writings of the main previous thinkers about mood disorders.Method-Representative contributions to writing on mood disorders over the past hundred years have been systematically evaluated.Results-The concept of two separate depressions does indeed emerge in the psychiatric literature from the very beginning of modern writing about the concept of 'melancholia'. For the principal nosologists of psychiatry, melancholic depression has always meant something quite different from non-melancholic depression. Exceptions to this include Aubrey Lewis and Karl Leonhard. Yet the balance of opinion among the chief theorists overwhelmingly favors the existence of two quite different illnesses. Conclusion-The concept of 'major depression' popularized in DSM-III in 1980 is a historical anomaly. It mixes together psychopathologic entities that previous generations of experienced clinicians and thoughtful nosologists had been at pains to keep separate. Recently, there has been a tendency to return to the concept of two depressions: melancholic and non-melancholic illness. 'Major depression' is coming into increasing disfavor. In the next edition of DSM (DSM-V), major depression should be abolished; melancholic mood disorder (MMD) and non-melancholic mood disorder (NMMD) should become two of the principle entities in the mood disorder section.

Palliative Medicine Practitioners' Views on the Concept of Depression in the Palliative Care Setting

“…This situation is not unique to the palliative care setting, as multitudinous concepts of depression have beleaguered the field of psychiatry over the course of its history [11][12][13] and continue to be actively debated. 13,14 The palliative care setting, however, arguably adds to the ambiguity because of the symptomatic similarities between depression and conditions commonly occurring at the end of life (EOL), such as illness and the dying processes and the attendant emotions in this context. 15,16 Health professionals have reported difficulties with assessing and managing depression in the palliative care setting.…”

The Major Depressive Disorder Hierarchy: Rasch Analysis of 6 Items of the Hamilton Depression Scale Covering the Continuum of Depressive Syndrome

“…For example, experienced psychiatrists always considered that MDD could be categorized between a biological, "endogenous" depression-called melancholic depression-and a psychogenic, "exogenous" depression-called non-melancholic depression [16,17]. This perception is supported by controversial evidences that melancholic patients would have genetic and biological determinants; more severe symptomatology; more evidence of neurobiological abnormalities, especially of the hypothalamic-pituitary-adrenal axis; low response to placebo; and superior response to pharmacological and electroconvulsive therapies [5,[18][19][20].…”

Estudos latino-americanos sobre melancolia: um transtorno do humor melhor definido para o CID-11

“…In particular, there has been extensive discussion on whether non-melancholic and melancholic depression are two separate conditions or reflect differences in the severity of a single syndrome. 6,7 In the section concerning mood and affective disorders of the [6][7][8][9][10][11][13][14][15]18 (see Table 2 26 Calil, in a non-systematic review, examined the Latin American concept of depression and presented a Brazilian proposal. 27 27,28 Banzato, in a non-systematic review, investigated classification issues in psychiatry: the move towards the ICD-11 and DSM-V. 29 The 30 10,36 In the 1990s, however, several studies found that the sensitivity of the DST for the diagnosis of the melancholic subtype of major depression as defined by the DSM-III was low (35-45%), although its specificity was high (70-89%).…”