Melancholia: Past and Present

Objective: To investigate commonalities in the clinical presentation of melancholia over time. Method: I conducted a comparative study to 2 epidemiologically complete databases from 1875-1924 and 1995-2005. Results: Patients in the historical period (1875-1924, compared with 1995-2005) with a diagnosis of melancholia show a classic profile of endogenous onset, with remission after 6 months, neurovegetative features, and, commonly, psychosis. The incidence of psychotic presentations appears to have fallen in recent decades. Patients in the contemporary period (1995-2010, compared with 1875-1924) at first admission for severe depressive disorders are more likely at an older age, more likely to go on to die by suicide, and will have much more frequent admissions. Conclusions: The data from this study support classical perceptions of melancholia. The poor outcomes in contemporary cases of severe depressive disorders support arguments for distinguishing between melancholia and other depressive disorders.