title: Co-morbidity and stability of melancholic features in DSM-IV major depressive disorder.
abstract: BACKGROUND
  The descriptive validity of the melancholic features specifier of the DSM-IV major depressive disorder (MDD) is uncertain. Little is known about its relationship to psychiatric co-morbidity, stability across episodes, or strength in predicting course of illness.
  
  
  METHODS
  The Vantaa Depression Study (VDS) is a prospective, naturalistic cohort study of 269 patients with a new episode of DSM-IV MDD who were interviewed with SCAN and SCID-II between 1 February 1997 and 31 May 1998, and again at 6 and 18 months. Ninety-seven (36%) MDD patients met DSM-IV criteria for the melancholic features specifier, and were contrasted with 172 (64 %) subjects with a non-melancholic MDD. The duration of the index episode was examined using a life chart.
  
  
  RESULTS
  We found no difference in rates of any current co-morbid Axis I or II disorders between melancholic and non-melancholic depressed patients. Of those who had melancholic features at the index episode and subsequent episodes during the 18-month follow-up, only 22 % (5/23) presented melancholic features during the latter. The non-melancholic subtype switched to melancholic in 25 % (8/32) of cases. Differences in the course of melancholic and non-melancholic depression were very minor.
  
  
  CONCLUSIONS
  The descriptive validity of the DSM-IV melancholic features specifier may be questionable in MDD. There appear to be no major differences in current co-morbidity, or course of depression between melancholic and non-melancholic patients. The consistency of DSM-IV melancholic features across episodes appears weak.
authors.affiliation: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Melartin
authors.forename: Ulla
authors.initials: U
authors.lastname: Leskelä
authors.forename: Heikki
authors.initials: H
authors.lastname: Rytsälä
authors.forename: Petteri
authors.initials: P
authors.lastname: Sokero
authors.forename: Paula
authors.initials: P
authors.lastname: Lestelä-Mielonen
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D000339:Affect; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications* / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000592:standards*