Melancholic Features

Note: The specifier “with melancholic features” is applied if these features are pres­ent at the most severe stage of the episode. There is a near-complete absence of the capacity for pleasure, not merely a diminution. A guideline for evaluating the lack of reactivity of mood is that even highly desired events are not associated with marked brightening of mood. Either mood does not brighten at all, or it brightens only partially (e.g., up to 20%–40% of normal for only minutes at a time). The “dis­tinct quality” of mood that is characteristic of the “with melancholic features” speci­fier is experienced as qualitatively different from that during a nonmelancholic depressive episode. A depressed mood that is described as merely more severe, longer lasting, or present without a reason is not considered distinct in quality. Psy­chomotor changes are nearly always present and are observable by others.

Melancholic features exhibit only a modest tendency to repeat across episodes in the same individual. They are more frequent in inpatients, as opposed to outpa­tients; are less likely to occur in milder than in more severe major depressive epi­sodes; and are more likely to occur in those with psychotic features.