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Letters to the Editor   |    
Melancholia as a Distinct Mood Disorder? Recommendations for DSM-5
James H. Kocsis, M.D.
Am J Psychiatry 2010;167:1534-1534. doi:10.1176/appi.ajp.2010.10070983
View Author and Article Information
New York, N.Y.

Dr. Kocsis has received research grant support from the Agency for Healthcare Research and Quality, the National Institute of Mental Health, the National Institute on Drug Abuse, AstraZeneca, Burroughs Wellcome Trust, CNS Response, Forest, Pritzker Consortium, and Roche; he has served on the speaker's bureaus of AstraZeneca, Merck, Pfizer, and Wyeth; and he has served on the advisory boards of Neurosearch, Pfizer, and Wyeth.

This letter was accepted for publication in September 2010.

Accepted September , 2010.

Copyright © American Psychiatric Association

To the Editor: In an editorial in the July 2010 issue of the Journal, Gordon Parker, M.D. (1), and a distinguished group of 16 coauthors, including one of the Deputy Editors of this journal, made an argument for melancholia being classified as a distinct mood disorder. The arguments that 1) melancholia features a cluster of symptoms with greater consistency than the broad heterogeneity of the disorders and conditions included in major depression and bipolar disorder and 2) the melancholia diagnosis has superior predictability for prognosis and treatment were not well supported by the evidence. For example, the statement that melancholic patients rarely respond to placebos, psychotherapies, or social interventions could equally well apply to severe major depression and psychotic major depression, both of which are major depression subtypes, as is melancholia, allowed as "specifiers" in the DSM-IV classification of major depression. Relevant literature reveals that hypercortisolemia is not specific to the melancholia diagnosis (2, 3). More importantly, in many studies the melancholia diagnosis lacks predictive value for treatment selection, including response to antidepressant medications or differential predictive value for response across classes of antidepressants (4, 5). Because each of the specifiers designated in DSM-IV shares characteristics with the larger domain of major depression and yet each has its own distinctive qualities (for melancholia it is a characteristic cluster of symptoms), it makes sense to retain the current system in DSM-5.

Parker  G;  Fink  M;  Shorter  E;  Taylor  MA;  Akiskal  H;  Berrios  G;  Bolwig  T;  Brown  WA;  Carroll  B;  Healy  D;  Klein  DF;  Koukopoulos  A;  Michels  R;  Paris  J;  Rubin  RT;  Spitzer  R;  Swartz  C:  Issues for DSM-5: Whither melancholia? The case for its classification as a mood disorder.  Am J Psychiatry 2010; 167: 745—747
[CrossRef] | [PubMed]
 
Stokes  PE;  Stoll  PM;  Koslow  SH;  Maas  JW;  Davis  JM;  Swann  AC;  Robins  E:  Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: a multicenter study.  Arch Gen Psychiatry 1984; 41: 257—267
[PubMed]
[CrossRef]
 
American Psychiatric Association Task Force on Laboratory Tests in Psychiatry:  The Dexamethasone Suppression Test: an overview of its current status in psychiatry.  Am J Psychiatry 1987; 144: 1253—1262
[PubMed]
 
Hirschfeld  RM:  Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs.  J Clin Psychiatry 1999; 60: 326—335
[CrossRef] | [PubMed]
 
Mallinckrodt  CH;  Watkin  JG;  Liu  C;  Wohlreich  MM;  Raskin  J:  Duloxetine in the treatment of major depressive disorder: a comparison of efficacy in patients with and without melancholic features.  BMC Psychiatry 2005; 5: 1
[CrossRef] | [PubMed]
 
References Container
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References

Parker  G;  Fink  M;  Shorter  E;  Taylor  MA;  Akiskal  H;  Berrios  G;  Bolwig  T;  Brown  WA;  Carroll  B;  Healy  D;  Klein  DF;  Koukopoulos  A;  Michels  R;  Paris  J;  Rubin  RT;  Spitzer  R;  Swartz  C:  Issues for DSM-5: Whither melancholia? The case for its classification as a mood disorder.  Am J Psychiatry 2010; 167: 745—747
[CrossRef] | [PubMed]
 
Stokes  PE;  Stoll  PM;  Koslow  SH;  Maas  JW;  Davis  JM;  Swann  AC;  Robins  E:  Pretreatment DST and hypothalamic-pituitary-adrenocortical function in depressed patients and comparison groups: a multicenter study.  Arch Gen Psychiatry 1984; 41: 257—267
[PubMed]
[CrossRef]
 
American Psychiatric Association Task Force on Laboratory Tests in Psychiatry:  The Dexamethasone Suppression Test: an overview of its current status in psychiatry.  Am J Psychiatry 1987; 144: 1253—1262
[PubMed]
 
Hirschfeld  RM:  Efficacy of SSRIs and newer antidepressants in severe depression: comparison with TCAs.  J Clin Psychiatry 1999; 60: 326—335
[CrossRef] | [PubMed]
 
Mallinckrodt  CH;  Watkin  JG;  Liu  C;  Wohlreich  MM;  Raskin  J:  Duloxetine in the treatment of major depressive disorder: a comparison of efficacy in patients with and without melancholic features.  BMC Psychiatry 2005; 5: 1
[CrossRef] | [PubMed]
 
References Container
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