0
Article |

The Diagnostic Validity of Melancholic Major Depression in a Population-Based Sample of Female Twins

Kenneth S. Kendler, MD
Arch Gen Psychiatry. 1997;54(4):299-304. doi:10.1001/archpsyc.1997.01830160013002.
Text Size: A A A
Published online

Background:  Although the diagnosis of melancholia is among the oldest in psychiatry, the validity of the melancholic subtype of major depression (MD) is still debated. If melancholia is a valid subtype of depression, is it quantitatively more severe than or qualitatively distinct from nonmelancholic depression?

Methods:  The lifetime history of MD and melancholia, defined by DSM-IV criteria, was assessed at interview in 1902 female twins selected from a population-based register. Patterns of comorbidity and the relationship between melancholia and risk for MD in the co-twin were assessed by logistic regression and Cox proportional hazards models, respectively.

Results:  In those with a lifetime history of MD, melancholia was associated with the following: (1) increased comorbidity with anxiety disorders and nicotine dependence but not alcohol dependence or bulimia; (2) greater number of episodes, more impairment, and help seeking; (3) lower levels of neuroticism; and (4) an increased risk of MD in cotwins—greater in monozygotic than in dizygotic pairs. Within twin pairs concordant for MD, no resemblance was found for melancholia. A multiple threshold model in which melancholic MD represented a quantitatively more severe form of depressive illness fitted the data well.

Conclusions:  Melancholia, defined by DSM-IV criteria, is a valid subtype of MD and identifies a subset of affected individuals with distinct clinical features and a particularly high familial liability to depressive illness. However, from a familial perspective, the differences between melancholic and nonmelancholic MD are quantitative, not qualitative. ie, melancholic MD is more severe than, but is not etiologically distinct from, nonmelancholic MD.

Topics

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Jobs
brightcove.createExperiences();