Treatment response in melancholia

Objective: Ascertain the response to specific depression treatments in melancholic and non‐melancholic depressed patients. Method: Literature review focusing on studies addressing symptoms, diagnostic profiles, severity and other predictors of outcome with antidepressant medication, electroconvulsive therapy (ECT), psychotherapy and placebo. Results: Patients with melancholia do not consistently differ from those with non‐melancholic depression in their response to antidepressants and ECT, but patients with melancholia show a significantly lower rate of placebo response. Depressed patients classified as severely ill‐many of whom are melancholic‐likewise do not differ from the less severely ill in response to antidepressants but do have a consistently lower placebo response rate. The little available data from psychotherapy studies also consistently show that melancholic and severely depressed patients are less likely than the more mildly depressed to improve with various types of psychotherapy. Depressed patients with increased pituitary‐adrenocortical activity‐most of whom are melancholic‐show a similar pattern of treatment response: they do well with ECT and antidepressants and poorly with placebo and psychotherapies. Conclusion: The research data, in the aggregate, suggest that the presence of melancholia predicts a poor response to psychotherapy and placebo and a relatively good response to antidepressants and ECT.