Melancholia: past and present.

OBJECTIVE To investigate commonalities in the clinical presentation of melancholia over time. METHOD I conducted a comparative study to 2 epidemiologically complete databases from 1875-1924 and 1995-2005. RESULTS Patients in the historical period (1875-1924, compared with 1995-2005) with a diagnosis of melancholia show a classic profile of endogenous onset, with remission after 6 months, neurovegetative features, and, commonly, psychosis. The incidence of psychotic presentations appears to have fallen in recent decades. Patients in the contemporary period (1995-2010, compared with 1875-1924) at first admission for severe depressive disorders are more likely at an older age, more likely to go on to die by suicide, and will have much more frequent admissions. CONCLUSIONS The data from this study support classical perceptions of melancholia. The poor outcomes in contemporary cases of severe depressive disorders support arguments for distinguishing between melancholia and other depressive disorders.