title: Melancholia: definition and management.
abstract: OBJECTIVE
  To overview historical ascriptions and the current nosological status of melancholia, before reporting diagnostic strategy, biological marker and treatment studies.
  
  
  RESULTS
  As melancholia has never been satisfactorily differentiated by reliance on symptoms, strategies that adopt a more prototypic approach and incorporate illness correlates in conjunction with symptoms appear to provide greater precision in differentiating melancholic and nonmelancholic depression. An early indicative biological marker--hyperactive Hypothalamic-Pituitary-Adrenal axis functioning--remains supported, whereas a number of other recently proposed candidate markers require clarification. Implications for treatment from recent clinical trials are also discussed.
  
  
  CONCLUSIONS
  We note that the Diagnostic and Statistical Manual 5 (DSM-5) definition of melancholia [as for Diagnostic and Statistical Manual IV (DSM-IV)] may be limited in its differentiating capacity and so compromise research into melancholia's causes and treatments. Clarifying melancholia's status, primary causes and differential treatment responsiveness awaits more precise definition of this depressive condition.
authors.affiliation: School of Psychiatry, University of New South Wales and Black Dog Institute, Sydney, New South Wales, Australia.
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.forename: Amelia
authors.initials: A
authors.lastname: Paterson
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000032:analysis; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology
chemical_list: D000928:Antidepressive Agents; D015415:Biomarkers