Finding a biosignature for melancholic depression

Abstract

Melancholia is typified by features of psychomotor slowing, anxiety, appetite loss and sleep changes. It is usually observed in 20–30% of individuals meeting diagnostic criteria for major depressive disorder (MDD). There is currently no agreement on whether melancholic MDD represents a distinct entity defined by neurobiological as well as clinical features or, rather, a specifier for MDD. This situation is reflected in the revisions to DSM, including in the DSM-5 due for release in 2013. With this context in mind, the authors review the origins of the construct of melancholia in MDD, its theoretical grounding and the defining characteristics that arose from this research. The authors then outline the state of knowledge on the neurobiology of melancholia. This second aspect is illustrative of the National Institutes of Mental Health’s research domain criteria initiative, which offers a framework for redefining constructs along neurobiological dimensions. The authors also consider the outlook for identifying a useful biosignature of melancholia.

Keywords::

• clinical and biological characteristics
• DSM-5
• entity
• historical context
• major depressive disorder
• melancholic depression
• neurobiologically motivated theories
• RDoC
• specifier

Acknowledgements

The authors would like to acknowledge the editorial support of Jon Kilner, MS, MA (Pittsburgh, PA, USA).

Financial & competing interests disclosure

CVA Day has received income and stock options with her current role as iSPOT Global Trial Manager. LM Williams has received consulting fees and stock options from Brain Resource and is a stockholder in Brain Resource Ltd. She has received Advisory Board fees from Pfizer. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No funded writing assistance was utilized in the production of this manuscript.