Non-melancholic depression

Non-melancholic depression is the most ‘common’ expression of depression seen by general practitioners in Australia.  It is also referred to as ‘major depression’, ‘clinical depression’, and ‘mixed anxiety and depression’ and is characterised by depressed mood for more than two weeks.  Individuals with non-melancholic depression tend to exhibit key features such as a decline in self-esteem, self-criticism, a depressed mood, as well as non-specific features, such as a change in appetite, fatigue or sleep disturbance. 

People with non-melancholic depression do not have the distinctive psychomotor disturbance seen in melancholic depression and are less likely to report major problems with anergy anhedonia, memory or concentration.  However, the challenge faced by general practitioners in treating this group is the high rate of ‘spontaneous remission’; hence, accurate assessment of treatment can be difficult (Parker, The Depressions 2002). 

Personality Styles and Sub-typing

Some sub-typing is possible, based on temperament and personality influences, although there is great overlap across expressions.  The Black Dog Institute’s model suggests that underlying personality features are amplified when the person is depressed.  In these non-melancholic depressions serotonergic dysfunction most like underpins depressed mood features and commonly drives anxiety.  The model suggests a link between personality and phenotypic expression of depression, as well as hinting at personality causes that may need to be modified by a relevant treatment approach. Stressors may be acute (e.g.  relationship breakdown, loss of job) or chronic ( e.g. dysfunctional marriage, disabled child, etc).

Common At-risk Personality Styles

• Anxious worrying: Reflecting high levels of internalised, on-going anxiety
• Irritability: Reflecting high levels of externalised, ongoing anxiety
• Social avoidance: Individuals avoid socialising for fear of embarrassment
• Personal reserve: Individuals are uncomfortable about sharing their feeling or opening up to others
• Self-criticism: Reflecting ongoing low self-esteem and self-worth
• Perfectionism: Reflecting self-imposed high standards
• Sensitivity to rejection: One’s own sense of self-worth is highly dependent on how they see other people reacting to them
• Self-focused:  Individuals focus more on their own needs than on other’s needs

Non-melancholic Depressive Disorders – Understanding an Episode

For a fuller discussion of the model and how to use it to help both the GP and the patient to understand a particular episode of depression please click here[PDF, 63KB].  This model can provide a holistic framework for formulating a case in many depression onsets, but particularly non-melancholic depression. 

Non-melancholic Depression Treatment principles

Serotonergic dysfunction probably underpins depressed mood features, and (commonly) drives anxiety – an SSRI is the treatment of choice if medication indicated.

Psychological treatments play a key role in addressing:  

• personality vulnerabilities
• current stressors
• patient priorities

The Psychological Toolkit

A psychological toolkit of useful resources has been compiled by the Black Dog Institute to assist the general practitioner in assessing, diagnosing, and managing patients with mood disorders who present to their clinic.  These can be used in a wide variety of psychological conditions but it is especially useful to use the materials to assist in assessing and managing patients who have been diagnosed with non-melancholic depression.

See The Psychological Toolkit