Management of melancholia.
There is increasing recognition that melancholic depression can be distinguished from other depressive types and that it differs from the nonmelancholic disorders in terms of its natural history, spontaneous remission rate, response to placebo and response to psychosocial and physical treatments. As it shows a preferential response to physical therapies, the psychotherapies are best viewed as adjunctive rather than primary treatments for melancholia. Of distinct importance, melancholia appears to show a differential response to differing antidepressant drugs, responding less well to the newer narrow-action antidepressant drug classes. For all these reasons, the management of melancholic depression needs to be distinguished from the management of 'depression' per se.
Parker
Gordon
G
School of Psychiatry, University of New South Wales, Euroa Centre, The Prince of Wales Hospital, High Street, Randwick, NSW 2031, Australia. g.parker@unsw.edu.au