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The severe form of depression you may not know about
By Edward Shorter, University of Toronto
Nov 04 2014
Melancholia is starting to be recognized again as a unique and severe form of depression that shouldn’t be treated with the standard prescriptions.
Feeling melancholy?
For most people, that word is straight out of an old English novel featuring long-haired poets languishing on mountain tops and nursing their broken hearts. In reality, it’s a serious disease that has been under-diagnosed and undertreated for decades. Thankfully, that’s changing.
Melancholia is starting to be recognized again as a unique and severe form of depression that shouldn’t be treated with the standard prescriptions.
Its hallmark is great sadness. People with melancholia also generally have slowed thought and movement, a complete absence of pleasure or no hope for the future. You may lose your period and your appetite as well. Your body feels completely out of whack. Those symptoms may also be experienced by people with more ordinary forms of depression. But the constant aching sadness gives away that you have melancholia.
With more typical forms of depression, you just don’t feel right in your body. You might feel very anxious, worried, angry, tired, “flat,” hopeless, helpless and more. Suicide remains a risk, but not like it is with melancholia.
The unbearable sadness and pain is bad enough, but it’s worse when you can’t feel anything at all. It’s this inability to feel, in severe melancholia, that makes people stop wanting to live. That brings me to the worst part of melancholia — the very real risk of suicide.
It’s a terrible form of depression, but the good news is that it’s highly treatable.
You may have to help educate your doctor about melancholia versus other forms of depression because this diagnosis wasn’t taught in medical schools during the last couple of decades. Very often, it doesn’t respond to Prozac, and other standard SSRI antidepressants that doctors give out as the first line of treatment.
A more effective treatment for melancholia is the older “tricyclic” class of antidepressants, which do come with more side effects and a longer wait time to kick in. If that doesn’t work, there are other options that you can discuss with your doctor.
It’s tough to estimate how many people suffer from melancholia because the illness has long been considered marginal, but I think it probably affects 2 to 3 per cent of Canadians at some point in their lives.
Senior psychiatrists today know about melancholia, because it was taught when they trained. Many younger ones will not, and often prescribe conventional Prozac-style antidepressants for “major depression,” with varying success. If you suspect you or a family member may have a melancholic illness, be sure to discuss this issue with your doctor, and don’t hesitate to ask for a referral to a psychiatrist if necessary.
Edward Shorter is the Jason A. Hannah Professor of the History of Medicine in the Faculty of Medicine of the University of Toronto and Professor of Psychiatry. He co-authored Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. If you have a question or comment for one of our experts, email doctorsnotes@thestar.ca .
By Edward Shorter, University of Toronto
Nov 04 2014
Melancholia is starting to be recognized again as a unique and severe form of depression that shouldn’t be treated with the standard prescriptions.
Feeling melancholy?
For most people, that word is straight out of an old English novel featuring long-haired poets languishing on mountain tops and nursing their broken hearts. In reality, it’s a serious disease that has been under-diagnosed and undertreated for decades. Thankfully, that’s changing.
Melancholia is starting to be recognized again as a unique and severe form of depression that shouldn’t be treated with the standard prescriptions.
Its hallmark is great sadness. People with melancholia also generally have slowed thought and movement, a complete absence of pleasure or no hope for the future. You may lose your period and your appetite as well. Your body feels completely out of whack. Those symptoms may also be experienced by people with more ordinary forms of depression. But the constant aching sadness gives away that you have melancholia.
With more typical forms of depression, you just don’t feel right in your body. You might feel very anxious, worried, angry, tired, “flat,” hopeless, helpless and more. Suicide remains a risk, but not like it is with melancholia.
The unbearable sadness and pain is bad enough, but it’s worse when you can’t feel anything at all. It’s this inability to feel, in severe melancholia, that makes people stop wanting to live. That brings me to the worst part of melancholia — the very real risk of suicide.
It’s a terrible form of depression, but the good news is that it’s highly treatable.
You may have to help educate your doctor about melancholia versus other forms of depression because this diagnosis wasn’t taught in medical schools during the last couple of decades. Very often, it doesn’t respond to Prozac, and other standard SSRI antidepressants that doctors give out as the first line of treatment.
A more effective treatment for melancholia is the older “tricyclic” class of antidepressants, which do come with more side effects and a longer wait time to kick in. If that doesn’t work, there are other options that you can discuss with your doctor.
It’s tough to estimate how many people suffer from melancholia because the illness has long been considered marginal, but I think it probably affects 2 to 3 per cent of Canadians at some point in their lives.
Senior psychiatrists today know about melancholia, because it was taught when they trained. Many younger ones will not, and often prescribe conventional Prozac-style antidepressants for “major depression,” with varying success. If you suspect you or a family member may have a melancholic illness, be sure to discuss this issue with your doctor, and don’t hesitate to ask for a referral to a psychiatrist if necessary.
Edward Shorter is the Jason A. Hannah Professor of the History of Medicine in the Faculty of Medicine of the University of Toronto and Professor of Psychiatry. He co-authored Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness. Doctors’ Notes is a weekly column by members of the University of Toronto’s Faculty of Medicine. If you have a question or comment for one of our experts, email doctorsnotes@thestar.ca .
