Melancholia (melancholic depression)

8-minute read

If you, or someone you know, is having suicidal thoughts and is in immediate danger, call triple zero (000). To talk to someone now, call Suicide Call Back Service 1300 659 467 or Lifeline on 13 11 14.

Key facts

Melancholia or melancholic depression is a type of depression, which is usually severe.
Symptoms often include slowed speech, thoughts and movements, along with a total loss of enjoyment in usual activities.
Effective treatments include psychotherapy, antidepressants and electroconvulsive therapy (ECT).
Your doctor or psychiatrist can recommend the best treatment plan for you.

What is melancholia?

The word ‘melancholia’ has been used since the time of the ancient Greeks. It describes a feeling of intense sadness and hopelessness. Melancholic depression is also known as ‘major depression with melancholic features’. People with melancholia lose interest in almost all activities and may also experience physical symptoms. Melancholic depression is usually a severe illness.

What are the symptoms of melancholia?

The symptoms of melancholia are similar to the general symptoms of depression but are usually more severe. Most people with melancholia slow down. Their movements, thoughts and speech can be very slow. Some people with melancholia experience agitation and restlessness, but this is less common.

If you have melancholia, you may:

feel slow and have a flat mood
show very little emotional expression or response
lose your appetite and lose weight
sleep badly, with either too much or too little sleep
have trouble concentrating and remembering things
have strong feelings of hopelessness or guilt
think about suicide

Symptoms are usually worse in the morning.

If you or someone you know is at immediate risk of harm from suicide, call triple zero (000). You can call Suicide Call Back Service 1300 659 467 or Lifeline on 13 11 14 for crisis support or if you are thinking about suicide.

What causes melancholia?

The cause of melancholia is not completely understood. It is believed to be caused by certain biological factors such as hormonal changes.

These are often hereditary — you are more likely to suffer from melancholia if you have a family history of depression, bipolar disorder or suicide. While stressful situations can trigger episodes of melancholia, they are generally thought not to be the main cause.

If you experience symptoms of psychosis, you may be more susceptible to melancholic depression.

When should I see my doctor?

If you are experiencing ongoing feelings of depression, disinterest or hopelessness, it’s important to see your doctor or a mental health professional. They can assess your symptoms and advise you on the best course of action.

Read more about mental health: where to get help.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How is melancholia diagnosed?

The first step to get help for any mental health problem is to see your doctor or a mental health professional. This includes depression with melancholic features. Your doctor may refer you to a psychiatrist for a more in-depth assessment and treatment plan.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

How is melancholia treated?

The treatment of depression, including melancholic depression, may involve antidepressant medicines, psychotherapy or a combination of the two. A mental health treatment plan from your GP can help with the cost of psychotherapy.

Physical treatments such as electroconvulsive therapy (ECT), or transcranial magnetic stimulation (TMS) are sometimes recommended if you have severe symptoms or if other treatments for depression have failed.

Information and support is available for people with melancholia and their friends and family.

Living with melancholia

Living with melancholia can be challenging, but with the right support and treatment, it can be managed. Seek help from healthcare professionals for tailored treatment plans, including medicines and therapy.

LOOKING FOR A MEDICINE? — To search by brand name or active ingredient, use the Medicines information search feature.

What are the complications of melancholia

Untreated melancholia can lead to serious complications, including difficulties with:

managing daily activities
maintaining relationships
managing your physical health

If you think you may have melancholia, speak to your doctor or mental health provider.

Resources and support

If you need help or would like talk to someone, there are organisations that can help:

Call Lifeline (24-hour crisis support) on 13 11 14 or chat online.
Contact the Suicide Call Back Service (phone and online counselling) — call 1300 659 467.
Kids Helpline offers online and phone counselling to young people aged 5 to 25 — call 1800 55 1800 or chat online.
Beyond Blue provides information, counselling and support for mental health — call 1300 22 4636 or chat online.
Beyond Now is a phone app that helps a person stay safe when experiencing suicidal thoughts.

State- and territory-based services

ACT — Mental Health Triage Crisis and Assessment Team: 1800 629 354
NSW — NSW Mental Health Line: 1800 011 511
NT — Northern Territory Mental Health Line: 1800 682 288
QLD — 13 HEALTH: 13 43 25 84
SA — Mental Health Triage Service: 13 14 65
TAS — Access Mental Health - Helpline: 1800 332 388
VIC — The Royal Melbourne Hospital Mental Health Service: (03) 9342 7000
WA — Mental Health Emergency Response Line: 1300 555 788

Aboriginal and/or Torres Strait Islander peoples

13Yarn is a free crisis support phone service run by Aboriginal and Torres Strait Islander people. Call: 13 9276 (13 YARN).
Black Dog Institute has social and emotional wellbeing resources for Aboriginal and/or Torres Strait Islander people.
Yarn Safe by headspace has free online support for young people aged 12 to 25 and their families.