Melancholic depression

Melancholic depression, or 'depression with melancholic features' is a subtype of major depression characterized by major depressive disorder with the following specific features: anhedonia (the inability to find pleasure in positive things), severe weight loss, psychomotor agitation or retardation, insomnia with early morning awakenings, and guilt. Another feature is diurnal variation, typically with worse symptoms in the morning and improvement at night. Melancholic depression is a particularly severe form of depression. Treatment involves: antidepressants, electroconvulsive therapy, and supportive psychotherapy, as deeper psychotherapy can not be tolerated. Roughly 10% of people with depression suffer from melancholic depression. According to DSM-IV the Melancholic features specifier may be applied to the following only:
 * 1) Major Depressive Episode, Single Episode
 * 2) Major Depressive Episode, Recurrent Episode
 * 3) Bipolar I Disorder, Most Recent Episode Depressed
 * 4) Bipolar II Disorder, Most Recent Episode Depressed